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Life Health > Health Insurance > Health Insurance

Exchanges to keep manual subsidy system

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The Centers for Medicare & Medicaid Services is planning to keep an emergency backup exchange plan reporting system in place for a while.

CMS will post a paperwork review notice about the system in the Federal Register Friday.

CMS set up the system for the carriers selling private “qualified health plans” through the PPACA exchanges.

PPACA created new tax credits to help moderate-income consumers pay for health coverage.

Consumers who have QHP coverage in 2014 and qualify for the credit can wait to get the money back when they file their 2014 tax returns, in 2015, or they can get an “advance premium tax credit” and use the subsidy to lower their monthly premium payments.

Originally, the exchanges were supposed to make QHP enrollee information flow to the QHP issuers automatically, and have the tax credit cash flow from the Internal Revenue Service to the QHP issuers automatically.

Because of all of the technical problems the exchanges have been having, CMS is having the 575 QHP issuers enter information about “effectuated enrollments” on a spreadsheet and return the spreadsheet to CMS as an e-mail attachment.

CMS filed the first paperwork review notice for the spreadsheet — Form CMS-10515 — in December. The agency now has to put a decision to extend use of the spreadsheet through another paperwork review process.

To use the spreadsheet, a worker at the carrier needs to have the carrier’s 5-digit Health Insurance Oversight System identity number and each QHP’s 16-digit HIOS plan ID number.

CMS is warning issuers to be careful about how they fill out the spreadsheet form. The system is supposed to treat blank fields as zero values, for example, but CMS is hoping issuers will take the time to put in zeros, not just leave cells blank. 

An issuer is supposed to report “total premium amount for effectuated enrollments by QHP ID.”

For an issuer in a state with an HHS-run exchange, the spreadsheet will calculate the issuer’s user fee payment automatically.

CMS and its parent, HHS, have a financial stake in maximizing QHP premium revenue: The HHS exchange user fee will be equal to 3.5 percent of the total QHP premiums collected.

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