On April 27, 2012, the IRS issued a proposed rule regarding the changes to section 6103(l)(21) of the Internal Revenue Code (IRC) – added by this section -- relating to the disclosure of return information to conduct eligibility determinations.
A March 23, 2012, HHS final rule on Medicaid eligibility included a clarification to a provision regarding the confidentiality and security requirements associated with MAGI data obtained from the IRS, including under IRC section 6103.
On August 1, IRS Deputy Principal Commissioner Daniel Werfel testified before the House Ways & Means Committee (also see the hearing page) regarding the IRS’s provision of taxpayer information to support ACA eligibility determinations, focusing on privacy and security safeguards and related issues.
On August 13, the IRS published final regulations regarding disclosure of certain return information to facilitate Health Insurance Marketplaces’ and state agencies’ eligibility functions. The IRS noted that disclosures of to HHS (including contractors) are “solely for purposes of, and to the extent necessary in” establishing Exchange eligibility, verifying advance premium tax credit and cost-sharing reduction amounts and assessing state program eligibility—specifically, for Medicaid, CHIP or a Basic Health Plan.
Also see an August 14 Notice in which CMS lays out the parameters of a data-matching program with the IRS under which federal tax return data related to premium subsidy, cost-sharing reduction, Medicaid, CHIP and Basic Health Plan eligibility determinations will be shared with CMS for use by the agency in Federally Facilitated Exchanges as well as via the Federal Data Hub, through which it can be accessed by Exchanges and state agencies. Comments are due in 30 days.
On August 30, CCIIO published a wide-ranging final rule (also see a factsheet) on Marketplace program integrity and other provisions, noting that it “generally is finalizing previously proposed policies without change.” The rule addressed oversight of Qualified Health Plan (QHP) issuers in Federally Facilitated Marketplaces; individual and SHOP eligibility appeals, including details on a “federally-managed appeals process [that] will be available for appellants in the individual market”; HHS privacy and security-related Marketplace compliance monitoring; an option for a state to operate a State-based SHOP, while having a Federally Facilitated Individual Marketplace; standards regarding issuers’ acceptance of various payment methods from Marketplace consumers; provisions addressing agents and brokers; QHP issuer direct enrollment; and a clarification regarding certain outside-the-Marketplaces plans’ participation in the risk corridors program.
SEC. 1414. DISCLOSURES TO CARRY OUT ELIGIBILITY REQUIREMENTS
FOR CERTAIN PROGRAMS.
(a) DISCLOSURE OF TAXPAYER RETURN INFORMATION AND SOCIAL
(1) TAXPAYER RETURN INFORMATION.—Subsection (l) of section
6103 of the Internal Revenue Code of 1986 is amended by
adding at the end the following new paragraph:
‘‘(21) DISCLOSURE OF RETURN INFORMATION TO CARRY OUT
ELIGIBILITY REQUIREMENTS FOR CERTAIN PROGRAMS.—
‘‘(A) IN GENERAL.—The Secretary, upon written request
from the Secretary of Health and Human Services,
shall disclose to officers, employees, and contractors of the
Department of Health and Human Services return information
of any taxpayer whose income is relevant in determining
any premium tax credit under section 36B or any
cost-sharing reduction under section 1402 of the Patient
Protection and Affordable Care Act or eligibility for participation
in a State medicaid program under title XIX of the
Social Security Act, a State’s children’s health insurance
program under title XXI of the Social Security Act, or a
basic health program under section 1331 of Patient Protection
and Affordable Care Act. Such return information
shall be limited to—
‘‘(i) taxpayer identity information with respect to
‘‘(ii) the filing status of such taxpayer,
‘‘(iii) the number of individuals for whom a deduction
is allowed under section 151 with respect to the
taxpayer (including the taxpayer and the taxpayer’s
‘‘(iv) the modified adjusted gross income (as defined
in section 36B) of such taxpayer and each of the
other individuals included under clause (iii) who are
required to file a return of tax imposed by chapter 1
for the taxable year, øAs revised by section
1004(a)(1)(B) of HCERA¿
‘‘(v) such other information as is prescribed by the
Secretary by regulation as might indicate whether the
taxpayer is eligible for such credit or reduction (and
the amount thereof), and
‘‘(vi) the taxable year with respect to which the
preceding information relates or, if applicable, the fact
that such information is not available.
‘‘(B) INFORMATION TO EXCHANGE AND STATE AGENCIES.—The
Secretary of Health and Human Services may
disclose to an Exchange established under the Patient Protection
and Affordable Care Act or its contractors, or to a
State agency administering a State program described in
subparagraph (A) or its contractors, any inconsistency between
the information provided by the Exchange or State
agency to the Secretary and the information provided to
the Secretary under subparagraph (A).
‘‘(C) RESTRICTION ON USE OF DISCLOSED INFORMATION.—Return
information disclosed under subparagraph
(A) or (B) may be used by officers, employees, and contractors
of the Department of Health and Human Services, an
Exchange, or a State agency only for the purposes of, and
to the extent necessary in—
‘‘(i) establishing eligibility for participation in the
Exchange, and verifying the appropriate amount of,
any credit or reduction described in subparagraph (A),
‘‘(ii) determining eligibility for participation in the
State programs described in subparagraph (A).’’.
(2) SOCIAL SECURITY NUMBERS.—Section 205(c)(2)(C) of the
Social Security Act is amended by adding at the end the following
‘‘(x) The Secretary of Health and Human Services,
and the Exchanges established under section 1311 of
the Patient Protection and Affordable Care Act, are
authorized to collect and use the names and social security
account numbers of individuals as required to
administer the provisions of, and the amendments
made by, the such Act.’’.
(b) CONFIDENTIALITY AND DISCLOSURE.—Paragraph (3) of section
6103(a) of such Code is amended by striking ‘‘or (20)’’ and inserting
‘‘(20), or (21)’’.
(c) PROCEDURES AND RECORDKEEPING RELATED TO DISCLOSURES.—Paragraph (4) of section 6103(p) of such Code is amended—
(1) by inserting ‘‘, or any entity described in subsection
(l)(21),’’ after ‘‘or (20)’’ in the matter preceding subparagraph
(2) by inserting ‘‘or any entity described in subsection
(l)(21),’’ after ‘‘or (o)(1)(A)’’ in subparagraph (F)(ii), and
(3) by inserting ‘‘or any entity described in subsection
(l)(21),’’ after ‘‘or (20)’’ both places it appears in the matter
after subparagraph (F).
(d) UNAUTHORIZED DISCLOSURE OR INSPECTION.—Paragraph (2)
of section 7213(a) of such Code is amended by striking ‘‘or (20)’’ and
inserting ‘‘(20), or (21)’’.