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Life Health > Health Insurance

Feds post PPACA risk program forms

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The Centers for Medicare & Medicaid Services is getting ready to pull health insurance data from tens of thousands of insurers, employers and benefit plan administrators. 

CMS expects 475 health insurers to fill out the forms to get “qualified health plans” — private exchange medical plans — certified, and 500 dental insurers to get dental QHPs certified.

CMS is also preparing to collect forms from many more coverage providers to run the new Patient Protection and Affordable Care Act “3 R’s” risk-management programs.

One is a temporary “risk corridor” program, or underwriting profit protection program, that will use money from all nongrandfathered individual and small-group plans to shield QHPs against antiselection.

Another is a temporary reinsurance program that will get cash from large-group issuers and self-insured plans as well as individual and small-group issuers, and the third is a permanent risk-adjustment program that will get contributions from and provide protection for all “risk-adjustment covered plans” — most nongrandfathered individual and small-group plans.

CMS is expecting to get data from 2,400 issuers of non-exchange individual and small-group plans for reinsurance and risk-adjustment program purposes, and data from 23,800 large-group issuers, self-insured group plans and benefit plan administrators for reinsurance program purposes.

CMS is putting the information collection programs through a paperwork review process. One purpose of the review process is to determine if an agency has a realistic idea about how much burden an information collection process will impose.

CMS is estimating that medical QHP certification will take an average of 147 hours and cost $11,319, and that dental QHP certification will take an average of 40 hours and cost $3,080.

The agency thinks 3 R’s program reporting for insurers in the individual and small-group markets will take just three hours and cost about $231, and that 3 R’s reporting for large-group insurers, self-insured plans and plan administrators will take five hours and cost about $385.

CMS would get the risk-corridor data from insurers’ annual PPACA medical loss ratio reports, which are due July 31.

CMS would get the other data using parts of the form QHP issuers will submit.

The 2015 QHP certification form includes attachment spreadsheets issuers are supposed to use to list their in-network providers and their business rules.

Under business rules, for example, a carrier is supposed to give the maximum number of dependents under age 21 used to quote rates for a two-person family; any maximum age for a dependent; and an explanation of how the carrier treats same-sex partners.

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