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Feds post 2015 PPACA technical documents

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The Center for Consumer Information & Insurance Oversight (CCIIO) has posted a guide states can use to fine-tune the population data health insurers use to come up with rates for residents.

CCIIO — the arm of the Centers for Medicare & Medicaid Services (CMS) in charge of managing the parts of the Patient Protection and Affordable Care Act (PPACA) that affect the commercial health insurance market — published this guide for states that want to replace the data in the standard federal Actuarial Value Calculator with state-specific data.

Health insurers are supposed to use a state’s AV calculator to design and price PPACA-compliant qualified health plans that fit into the bronze, silver, gold and platinum metal level system.  A bronze plan is supposed to cover about 60 percent of the actuarial value of the PPACA essential health benefits (EHB) package, and a top-level, platinum plan is supposed to cover about 90 percent of the actuarial value of the EHB package.

CCIIO has also published a collection of federal Actuarial Value Calculator Continuance Tables, or tables that describe “the distribution of claims spending for a population of health insurance users who face a particular benefit structure,” officials say.

To qualify to replace the federal calculator data with state data, a state must blend 48 continuance tables of its own for every combination of metal level, gender and age bracket into 12 continuance tables weighted to a fit a defined standard population, officials say.

A state is supposed to get data mainly for people in preferred provider organization plans and point-of-service plans, and it’s supposed to try to get 100,000 enrollee experiences per metal tier for each of the 12 final continuance tables. The data sources must include allowed charges incurred by the plans, even if a reinsurer or other program helped pay the claims.

A state that decides to feed its data into the calculator must stick with that decision for an entire benefit year, officials say.

CCIIO also has published a Health Insurance Oversight System Plan Finder — Issuer User Manual. The Health Insurance Oversight System (HIOS) is the system CCIIO and CMS use to exchange information with the state insurance regulators and insurance companies participating in the public health insurance exchange program.

The Plan Finder module is the HIOS system that collects general identification information and product information from exchange plan issuers. 

Authors of the manual talk mainly about technical issues, such as what to do if the Plan Find system says the user has set spreadsheet software macro security settings too high. Users who need extra help are told to call an Exchange Operations Support Center (XOSC) at a CMS Help Desk from 9 a.m. ET through 6 p.m. ET Monday through Friday.


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