Brady is chief marketing officer at Acero Health Technologies, a company that sets up software systems for health insurers and health plan administrators. It has already put together cost-sharing subsidy tracking and reconciliation systems for a handful of QHP issuers. Some sell QHPs through state-based exchanges, and some sell QHPs through the exchanges run by the U.S. Department of Health and Human Services (HHS).
So far, Brady said, he hasn’t heard Acero insurer clients complaining about how the cost-sharing subsidy system works. In the Acero Health customer universe, “everybody’s paying claims right now,” Brady said. “Our clients are receiving the money.”
CMS has not yet developed the final data format for the cost-sharing reduction reports that QHP issuers will have to send CMS in 2015, to reconcile the cost-sharing subsidy amounts that CMS actually paid in advance with what CMS should have paid. But the reconciliation reports will not be due until 2015, and Brady said he is confident that the insurers using his company’s system are collecting the right data to feed into the final reporting system.
Brady acknowledged that he only knows what’s happening at Acero Health client insurers, and that they wouldn’t necessarily rush to him with news of problems. But, at this point, he said, “I’m not aware of any problems.” He said he thinks the insurers he works with are using an interim system developed by HHS to send estimated CSR amounts to the Centers for Medicare & Medicaid Services (CMS) — the arm of HHS that runs the exchanges. He believes CMS is sending the insurers money back.
Some other insurance information technology specialists have said they think the Patient Protection and Affordable Care Act (PPACA) public exchange programs may be facing serious back-office processing problems.
See also: IT strategist: Exchanges face more pain
In Minnesota, for example, a consulting firm recently concluded that the state-based MNsure exchange has suffered from not having an information technology project director. That exchange and others face tight deadlines due to efforts to improve or replace systems that performed poorly during the 2014 individual QHP open enrollment period, which started Oct. 1, 2013, and ended in mid-April in most of the country.
HHS posted monthly QHP enrollment activity reports on the Web during the open enrollment period. Information about the state of the back-end systems running the new public exchange plans is harder to get than information about exchange plan enrollment was. At this point, publicly traded health care providers are just starting to talk about how PPACA is affecting the odds that patients will have private insurance or Medicaid. The providers are not yet saying much about how quickly exchange QHPs or other PPACA-compliant plans pay their bills.
The QHP issuers are just starting to talk about the QHP enrollees and have not yet said much about whether, and how quickly, the government is paying the advanced premium tax credit (APTC). The relatively well-known APTC program helps low-income and moderate-income QHP buyers pay the QHP premiums.
The smaller, less publicized cost-sharing subsidy program helps the lowest-income QHP buyers pay plan deductibles, co-payments and coinsurance amounts. A very low-income consumer may sign up for a silver plan that pays 70 percent of the actuarial value of a standardized essential health benefits (EHB) programs. For that low-income consumer, the government uses cost-sharing reduction subsidies to make sure the plan pays the equivalent of 94 percent of the actuarial value of the EHB package.
QHP issuers will be able to choose between creating reconciliation reports using a simplified cost calculation method and a more complicated standard method that might help an issuer maximize actual subsidy amounts.
Acero Health relies mainly on public regulations and standards documents to create its systems, not on face-to-face meetings with CMS officials. But Brady said he has submitted questions to CMS through a “frequently asked questions” system. CMS has answered the questions it’s ready to answer, and the CMS representatives who replied came up with good answers written at the right level of sophistication, Brady said.