ACA Now

On July 30, 2014 CMS published a notice requesting OMB’s emergency review of proposed changes to a currently OMB-approved information collection. The agency says “as a result of contractor changes and technical design changes to our distributed data collection (DDC) approach for implementing the risk adjustment and reinsurance programs, we must change the data elements that issuers will submit as part of the DDC information collection requirements,” adding that “these modifications will permit us to register EDGE servers with the appropriate issuer accounts, permitting CMS to make risk adjustment and reinsurance payments to issuers.” Comments are due by Aug. 27 2014.

On Aug. 22, CCIIO released slides from a reinsurance user group that, on slides 5-6, recap key deadlines for the 2014 benefit year. On August 7, CMS posted an FAQnoting that “there are no exemptions from the obligation to make reinsurance contributions specifically available to religious organizations; however, other exemptions may apply” as denoted in the applicable regulatory section. On August 11, in slides and additional guidance, CMS presented key details of contributing entities’ documentation submission for the ACA reinsurance program, such as file layout parameters for legal business name, contributing entity type, benefit year, annual enrollment count and other information. On August 11, CCIIO created a page on the ACA reinsurance program that includes background information includes defining contributing entities for ACA reinsurance purposes, discussing the process for making contributions via pay.gov, listing specific deadlines for the 2014 benefit year and providing links to further information.

On August 26, CCIIO issued a guide providing an overview of setting up an Amazon EDGE Server account for distributed data collection under ACA reinsurance and risk adjustment programs, as well as a separate document with guidance to insurers pre-configuring an on-premise EDGE server. On August 12, CCIIO released version 3.0 of the business rules guide for EDGE Server data submission. The agency discusses file processing rules for specified types of claims files and diagnosis codes. On August 7, CCIIO posted slides reviewing key deadlines for distributed data collection processes.

On Oct. 21, in a final step before formal publication in the Federal Register, CCIIO sent the proposed rule on “CY 2016 payment parameters for the cost-sharing reductions, advance payments of the premium tax credit, reinsurance, and risk adjustment programs as required by the Affordable Care Act” to OMB for final approval.

On Oct. 29, CMS posted several FAQs on the Registration for Technical Assistance Portal (REGTAP) (account required) addressing the process of making reinsurance contributions and calculating the number of covered lives, among other operational issues (e.g., here, here, here, here and here). On Oct. 24, CMS posted the Reinsurance Program Annual Contribution Submission Form on pay.gov. See here. On Oct. 7, CMS posted a REGTAP FAQ on audits of the number of covered live counts underlying reinsurance contributions.

On Nov. 17, CCIIO said plans and other contributing entities now have until Dec. 5, 2014, to submit their 2014 annual enrollment counts for the ACA reinsurance program. Payment deadlines for remitting contribution amounts (Jan. 15, 2015, and Nov. 15, 2015) are unchanged. On Nov. 3, CCIIO posted slides providing an overview of the reinsurance contribution process.

On Nov. 14, CMS posted FAQs (e.g., here and here) on its Registration for Technical Assistance Portal addressing EDGE Servers for data collection. On Nov. 10, HHS released a recap of key technical assistance issues in implementing EDGE servers.

On Nov. 23, CMS released a wide-ranging proposed rule, the 2016 Notice of Benefit and Payment Parameters (press release; fact sheet), addressing the ACA risk adjustment, reinsurance and risk corridors programs; cost-sharing parameters; Marketplace prescription drug coverage and other dimensions of essential health benefits (EHBs); QHP contracting with essential community providers; and rate review, among other issues that generally apply to 2016 coverage. Consistent with Nov. 4 guidance, the rule also proposes that employer plans not including substantial coverage of inpatient hospitalization or physician services would not meet ACA minimum value criteria. Comments are due by Dec. 22.

On Nov. 26, CMS posted a Paperwork Reduction Act (PRA) package containing the Quality Improvement Strategy Reporting Template discussed in the proposed 2016 Notice of Benefit and Payment Parameters. Also see a Nov. 26 PRA package stemming from the 2016 notice’s discussion of states’ 2017 opportunity to update essential health benefits benchmark plans.

On Jan. 13, 2015, CCIIO posted a weekly update on distributed data collection through EDGE Servers addressing “common schema tables and expected rows” and reinsurance calculation logistics, among other topics. Also see a Jan. 27, 2015, weekly update and set of release notes (REGTAP account required) as well as a Dec. 12 edition of the weekly update. On Dec. 19, as detailed here, CMS delayed the deadline for issuers to submit the first EDGE server production file until Dec. 28. This followed another extension of the original Dec. 5 deadline announced earlier in the month

On Feb. 2, CMS posted a weekly update on EDGE server implementation. On Feb. 19, announced that in response to issuer requests, it would run another risk adjustment and reinsurance calculation on Feb. 23; it also provided guidance for those with unsuccessful Feb. 12 runs and a Feb. 27 software upgrades.

On Feb. 20, CMS finalized the wide-ranging final 2016 Notice of Benefit and Payment Parameters rule that addresses – among other topics – ACA premium stabilization, Marketplace open enrollment and user fee, rate review, essential health benefits, prescription drug coverage and other issues generally affecting Qualified Health Plans (QHPs) for the 2016 benefit year. Also see a fact sheet. Additionally, on Feb. 20, CCIIO finalized the 2016 letter to health insurance issuers in the Federally Facilitated Marketplace, which addresses QHP certification timelines, benefit design, essential community providers, network adequacy and other issues.

On Mar. 4, CMS said that having released a software upgrade for EDGE servers, it now plans to run the latest ACA reinsurance and risk adjustment calculations on Mar. 10 instead of on Mar. 5. Also on Mar. 4, the agency posted FAQs QHPs’ registration with Pay.gov (here); access to the Marketplace and Premium Stabilization Programs Payment Form (here); and process for completing the form (here). In a Mar. 24 FAQ, CMS clarified that QHPs may use the rendering provider ID as the billing provider ID if the latter is not available.

On Apr. 15, CCIIO said ACA reinsurance collections are expected to fall just short of the $10 billion statutory pool for non-grandfathered health plans with no funds for the $2 billion Treasury or $20 million admin cost contributions.

On Apr. 27, CCIIO posted a bulletin affording a “grace period for issuers to submit and update EDGE server data for the 2014 benefit year financial transfers through Friday, May 15, 2015, 4:00 p.m. EDT”; such data otherwise was due Apr. 30. CCIIO indicated the grace period would “not delay CMS’ transmission of risk adjustment and reinsurance results to issuers by Jun. 30, 2015.”

On May 8, CCIIO posted slides reviewing the steps involved in computing ACA reinsurance payments based on EDGE server data (slide 6). On May 20, CCIIO issued guidance explaining the formal discrepancy reporting procedures that apply to outbound EDGE server risk adjustment and reinsurance estimate reports.

On June 1, GAO released a report, “Despite Some Delays, CMS Has Made Progress Implementing Programs to Limit Health Insurer Risk.

On June 5, CCIIO posted a log of updates to EDGE server processes. On June 30, CCIIO released a report on 2014 benefit year reinsurance payments and risk adjustment transfers by insurance issuer. Also see a press release and details on issuers’ administrative appeals processes.

On June 17, CCIIO posted guidance indicating that 2014 benefit year contributions under ACA transitional reinsurance exceeded payment requests and announced that it is adjusting 2014 reinsurance (to 100% coinsurance) to be more generous in covering non-grandfathered individual market plans’ high-cost claims within defined parameters.

On July 7, CMS released a technical correction to its 2016 Notice of Benefit and Payment Parameters final rule.

On July 16, CCIIO said it will not conduct risk adjustment validation testing using 2014 data. The remaining timeline will proceed as anticipated, with testing in 2016 based on 2015 data and adjustment in 2018 based on 2016 data.

On July 29, CMS released slides outlining the payment and invoice process for ACA risk adjustment and reinsurance payments, including netting from advance cost-sharing reductions and premium subsidies.

On Sept. 21, CMS released FAQs on 2014 reinsurance collections (here) and employer counting processes for employees with primary Medicare coverage (here).

On Sept. 2, CMS posted an FAQ confirming that the 2015 EDGE server registration and provisioning process is the same as 2014.

On Sept. 18, CCIIO updated its June 30 report on ACA reinsurance payments and risk adjustment transfers for the 2014 benefit year to account for additional and corrected data since the original release.

2016

On Jan. 20, 2016, CCIIO released guidance explaining how it will assess QHPs’ submission of EDGE server submissions for ACA risk adjustment and reinsurance interim reports during the 2015 benefit year.

On Feb. 12, CCIIO estimated it will have $7.7 billion in ACA reinsurance contributions for the 2015 benefit year, including $1.7 billion in carryover contributions from last year. The agency plans to make an early payment at a 25 percent coinsurance rate in March 2016, as previously finalized. Additional details on 2015 benefit year payments and the final coinsurance rate will be announced in June 30 payment reports.

On Feb. 24, Secretary Burwell testified on the HHS FY 2017 Budget Request at a House Energy and Commerce Committee hearing and discussed, among other topics, Exchange eligibility issues and HHS authority for ACA reinsurance payments.

On May 5, CMS released a guide for QHPs addressing the attestation and discrepancy reporting process for ACA risk adjustment and reinsurance for the 2015 benefit year.

On June 17, CCIIO announced that the 2015 Benefit Year reinsurance coinsurance rate would be an estimated 55.1 percent.

On June 23, CMS posted FAQs addressing the process for distributing ACA reinsurance payments to eligible plans (here). In an accompanying FAQ, the agency responds to questions about the eligibility of student health plans (here).

On June 30, CMS released a summary report conveying preliminary estimates of overall and issuer-specific risk adjustment payments and transfers, as well as reinsurance payments, for the 2015 benefit year.

On July 22, CMS transmitted the Calendar Year 2018 Notice of Benefit and Payment Parameters proposed rule to OMB for regulatory review, marking a final step before the proposal is issued for public comment through the Federal Register.

On Aug. 26, CMS posted the latest details on 2016 data submission through EDGE servers, including current implementation status and technical specifications.

On Aug. 30, CMS released slides describing its web-based process for QHPs’ reporting on the status of their EDGE servers for 2016 benefit year data submission.

On Sept. 20, CMS posted slides addressing ACA reinsurance supporting documentation as well as slides on counting methods.

On Sept. 21, CMS issued an FAQ recapping the steps that contributing entities follow as part of the ACA reinsurance collections process.

On Sept. 29, the GAO released a decision concluding that “HHS lacks authority to ignore the statute’s directive to deposit amounts from collections under the transitional reinsurance program in the Treasury and instead make deposits to the Treasury only if its collections reach the amounts for reinsurance payments specified in section 1341.”

On Oct. 5, CMS posted slides that provide an overview for QHPs preparing for Nov. 9 data submission via EDGE servers.

On Oct. 6, CMS posted slides reviewing top issues with the ACA risk adjustment data validation audit tool, including procedures for delegating senior official functions (see slides 6-17).

In an Oct. 11 FAQ, CMS highlighted five “notable changes” for the 2016 Benefit Year ACA reinsurance contributions process.

On Oct. 13, CMS released slides discussing the process for QHPs’ baseline data submission through EDGE servers for ACA reinsurance and risk adjustment for the 2016 benefit year.

On Oct. 17, CMS released a manual explaining how contributing entities and contractors may address common discrepancies in 2016 ACA reinsurance enrollment and contribution forms.

On Nov. 18, CCIIO posted a key dates chart that highlights, on p. 3, milestones for the 2016 benefit year ACA reinsurance and risk adjustment programs.

On Dec. 6, 2016, CCIIO issued an adjusted report on 2015 benefit year ACA transitional reinsurance and permanent risk adjustment payments and charges.

On Dec. 16, 2016, CMS released the Calendar Year (CY) 2018 Notice of Benefit and Payment Parameters final rule. The wide-ranging annual Exchange rule addresses ACA risk adjustment and an array of policies affecting QHPs.

2017

On April 13, CMS released slides on the ACA risk adjustment data validation audit tool beginning on slide 8. The agency discusses key steps for the audit tool’s registration process, which opens on April 14.

On May 9, CCIIO announced that the form used in ACA risk adjustment and reinsurance attestation and discrepancy reporting is now available here.

On May 11, CMS released a guide for QHPs on ACA reinsurance and risk adjustment attestation and discrepancy reporting, including how to use the web-based form to attest and report any applicable discrepancies.

On June 30, CMS released a report, “Summary on Transitional Reinsurance Payments and Permanent Risk Adjustment Transfers for the 2016 Benefit Year.” It found that “both the transitional reinsurance program and the permanent risk adjustment program are working as intended in compensating plans that enrolled higher-risk individuals, thereby protecting issuers against adverse selection within a market within a state and supporting them in offering products that serve all types of consumers.”

On July 12, the House Democrats’ Affordable and Accessible Health Care Task Force released a plan to stabilize the individual market.

On Sept. 21, CMS transmitted the Calendar Year 2019 Notice of Benefit and Payment Parameters proposed rule to OMB for regulatory clearance, a final step before the rule is released for public comment.