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February 05, 2013 at 09:23 AM
The Centers for Medicare & Medicaid Services (CMS) will have to create a big new system of records to support the new health insurance exchanges (HIX).
CMS is giving a little bit of information about how the new record system — the HIX program — will work in a notice to be published Wednesday in the Federal Register.
The federal Privacy Act of 1974 requires CMS to publish a privacy notice when it sets up new record systems.
The PPACA HIX program
The Patient Protection and Affordable Care Act of 2010 (PPACA) requires the U.S. Department of Health and Human Services (HHS) — the parent of CMS — to work with state agencies to set up a system of individual and small group exchanges, or health insurance supermarkets, by Oct. 1.
The exchanges are supposed to use one application process to help consumers find out whether they are eligible for health coverage subsidies or for exemptions from the PPACA “shared responsibility” health insurance ownership mandate.
An exchange program “Data Services Hub” will help exchanges get eligibility information and check applications by pulling data from the Internal Revenue Service, the Social Security Administration, the U.S. Department of Homeland Security, the U.S. Department of Veterans Affairs, the U.S. Department of Defense, the Peace Corps and the federal Office of Personnel Management.
The exchanges also will share ”personally identifiable information” (PII) with the health insurers that sell coverage through the exchanges; “Navigators,” or official PPACA exchange ombudsmen; “marketplace assisters,” or exchange employees who help consumers use the exchange; and insurance agents and brokers.
States with their own exchanges will be responsible for handling some types of exchange data, and the CMS-run “federal facilitated exchanges” will handle other types of data, officials said.
For all exchanges, CMS will administer the new PPACA health insurance purchase tax credit program and the new “cost-sharing reduction” program, officials said.
