CMS will let PPACA exchange plan issuers use virtual servers in the Amazon Cloud or have physical servers in their offices.

The Centers for Medicare & Medicaid Services (CMS) are tweaking the rules public exchange plan issuers have to follow when they feed plan data into the new federal health insurance risk-management programs.

CMS will now let insurers choose between keeping risk program physical “servers,” or computers, in their offices, or setting up Amazon Cloud accounts that behave like servers. The agency talks about the changes in a filing it used to change the information it can collect for the risk program data filing system.

The insurers that sell qualified health plans (QHPs) through the Patient Protection and Affordable Care Act (PPACA) use the data filing system to send CMS the data the agency needs to run a temporary PPACA reinsurance program and a permanent PPACA risk-adjustment program.

The reinsurance program is supposed to use carrier fee income to pay part of the bill when an insurer has an enrollee with big claims. The risk-adjustment program is supposed to use cash from insurers with many low-risk enrollees to help insurers with many high-risk enrollees.

Technically, CMS was asking the Office of Management and Budget for permission to get Amazon Cloud EDGE Server account registration information from the insurers. CMS needs that information to send the insurers risk program payments, officials say.

Steve Kelmar, an executive vice president at Aetna, wrote to CMS to clarify if they might be expecting an insurer to have one physical server, or one server-like Amazon Cloud account, for each issuing entity. That would cause big problems for Aetna, because Aetna has 95 issuing entities, Kelmar wrote.

CMS officials say in a response that an insurer needs a separate Health Insurance Oversight System (HIOS) issuer ID for each issuer, and that the insurer needs to set up a separate “server instance,” or software equivalent of a server computer, for each issuer. But an insurer can put more than one server instance in its Amazon Cloud account, and it can put more than one server on a physical server computer in its offices, officials say.