Close Close

Life Health > Health Insurance > Health Insurance

Open questions slow PPACA exchange revamp

Your article was successfully shared with the contacts you provided.

Public health insurance exchange technology contractors and exchange plan issuers are still having trouble figuring out what the Obama administration wants.

The U.S. Government Accountability Office (GAO) talked about the effects of unanswered questions on U.S. Department of Health and Human Services (HHS) exchange program systems in a report released last week. 

See also: GAO: Federal PPACA exchanges are open to fake people

The Centers for Medicare & Medicaid Services (CMS), a division of HHS, hired Accenture to revamp HHS public exchange computer systems in January. CMS told Accenture that the firm had to get a financial management module for the HHS-run exchanges working by mid-March. Instead, GAO officials say, Accenture worked from January through April on figuring out what the previous contractor had done — and on clarifying CMS requirements.

As of June 5, 2014, CMS had changed Accenture’s original Patient Protection and Affordable Care Act (PPACA) exchange systems development contract six times to modify existing requirements and add enhancements, GAO officials say. CMS is now hoping Accenture can implement the financial management module in several phases between now and December 2014.

GAO officials say the financial management module delays have hurt the ability of CMS to:

  • Track eligibility and enrollment transactions at the HHS-run exchanges.
  • Make subsidy payments to the insurers that sold qualified health plans (QHPs) through HHS-run public exchanges.
  • Exchange consumer data with the Internal Revenue Service.
  • Run the new PPACA risk-management programs.

CMS has named Andy Slavitt to be the principal deputy administrator at the Centers for Medicare & Medicaid Services (CMS) in charge of overseeing the Center for Consumer Information & Insurance Oversight (CCIIO). CCIIO is the CMS division responsible for day-to-day management of the HHS-run exchanges and the state-based PPACA exchanges.

Slavitt testified last week at a House Energy & Commerce subcommittee hearing that HHS has tried to address some of the problems the GAO identified by hiring him to make the second individual QHP open enrollment period run more smoothly than the first. Before going to work for CMS three weeks ago, Slavitt had been an executive vice president at the Optum unit at UnitedHealth Group Inc. (NYSE:UNH). Several states have given Optum credit for getting stalled exchange systems up and running.

In a written response to the GAO report, HHS said CMS will also be hiring a chief executive officer (CEO) and a chief technology officer (CTO) for the exchange program. CMS officials first talked about hiring the exchange program CEO and CTO in June. It’s not yet clear whether CMS has filled those positions. At press time, the CCIIO leadership page did not mention Slavitt, an exchange CEO, an exchange CTO, or Dr. Mandy Cohen, who has been the acting CMS director. Only three of the eight CCIIO units had permanent directors listed. Four had acting directors listed, and one had no acting or permanent director listed.

The first QHP open enrollment period started Oct. 1, 2013, and ended in mid-April in most of the country. The second is set to start Nov. 15. 

Health insurers are already filing 2015 exchange QHP form and rate applications with state insurance departments. CCIIO is still developing major components of the 2015 QHP application packet. Sometime between July 30 and Aug. 4, for example, CCIIO added a note to the QHP application Web page stating that, “Stand-alone dental plan instructions and network adequacy instructions are forthcoming.” The note means insurers issuers still lack firm, detailed information they can use to choose which doctors, clinics and hospitals to put in their provider networks.