124 STAT. 174 PUBLIC LAW 111–148—MAR. 23, 2010 if the Exchange has adequate resources to assist such individ- uals and employers. (c) RESPONSIBILITIES OF THE SECRETARY.— (1) IN GENERAL.—The Secretary shall, by regulation, estab- lish criteria for the certification of health plans as qualified health plans. Such criteria shall require that, to be certified, a plan shall, at a minimum— (A) meet marketing requirements, and not employ mar- keting practices or benefit designs that have the effect of discouraging the enrollment in such plan by individuals with significant health needs; (B) ensure a sufficient choice of providers (in a manner consistent with applicable network adequacy provisions under section 2702(c) of the Public Health Service Act), and provide information to enrollees and prospective enrollees on the availability of in-network and out-of-net- work providers; (C) include within health insurance plan networks those essential community providers, where available, that serve predominately low-income, medically-underserved individuals, such as health care providers defined in section 340B(a)(4) of the Public Health Service Act and providers described in section 1927(c)(1)(D)(i)(IV) of the Social Secu- rity Act as set forth by section 221 of Public Law 111– 8, except that nothing in this subparagraph shall be con- strued to require any health plan to provide coverage for any specific medical procedure; (D)(i) be accredited with respect to local performance on clinical quality measures such as the Healthcare Effectiveness Data and Information Set, patient experience ratings on a standardized Consumer Assessment of Healthcare Providers and Systems survey, as well as con- sumer access, utilization management, quality assurance, provider credentialing, complaints and appeals, network adequacy and access, and patient information programs by any entity recognized by the Secretary for the accredita- tion of health insurance issuers or plans (so long as any such entity has transparent and rigorous methodological and scoring criteria); or (ii) receive such accreditation within a period estab- lished by an Exchange for such accreditation that is applicable to all qualified health plans; (E) implement a quality improvement strategy described in subsection (g)(1); (F) utilize a uniform enrollment form that qualified individuals and qualified employers may use (either elec- tronically or on paper) in enrolling in qualified health plans offered through such Exchange, and that takes into account criteria that the National Association of Insurance Commis- sioners develops and submits to the Secretary; (G) utilize the standard format established for pre- senting health benefits plan options; and (H) provide information to enrollees and prospective enrollees, and to each Exchange in which the plan is offered, on any quality measures for health plan perform- ance endorsed under section 399JJ of the Public Health Service Act, as applicable. Regulations.
