The federal government is supposed to do more than help moderate-income consumers pay the premiums for “qualified health plan” (QHP) coverage. The Patient Protection and Affordable Care Act (PPACA) also calls for the government to help purchasers of silver-level QHPs who earn enough to qualify for QHP premium subsidies, but less than 250 percent of the federal poverty level, handle out-of-pocket expenses — deductibles, co-payments and coinsurance amounts.
The Centers for Medicare & Medicaid Services (CMS) talk a little about the “cost-sharing reduction” (CSR) program in a routine paperwork review notice that’s set to appear in the Federal Register Friday.
CMS officials say that, once the CSR system is working the way the parent of CMS, U.S. Department of Department of Health and Human Services (HHS), wants the system to work, the QHP issuers will get advance CSR payments throughout the year.
After the end of the year, CSR program managers will use a reconciliation process to see whether it paid the QHP issuers the right CSR amounts. Program managers are supposed to send more money to issuers that got too little, and take money from issuers that got too much.
The paperwork review notice covers the data elements managers will need to get to run the reconciliation process. Many consultants are trying to give the QHP issuers advice about how to handle the reconciliation process.
Truven Health Analytics presented a session on the topic at the recent America’s Health Insurance Plans (AHIP) annual meeting. Infogix is another company that’s been advising insurers on CSR program compliance.