A federal agency has posted a small package of spreadsheets that could be the focus of years of battles between insurers and regulators.
The Center for Consumer Information & Insurance Oversight (CCIIO) is creating the wrestling ground by posting draft versions of the Risk Corridors 2014 Plan-Level Data Form.
Insurers that sell qualified health plans (QHPs) through the Patient Protection and Affordable Care Act (PPACA) exchange system are supposed to use the form to tell CCIIO how much money they made or lost on QHP business. CCIIO is supposed to get the highly profitable issuers to pay money in to the system, then use the money to help the issuers with poor operating results.
When an issuer fills out the form, it’s supposed to list each plan’s total billable premium and the plan’s share of marketwide premiums for non-grandfathered, PPACA-compliant plans. There are separate sections for individual product information and small-group plan information.
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CCIIO is an arm of the Centers for Medicare & Medicaid Services (CMS), which is, in turn, part of the U.S. Department of Health and Human Services (HHS). CCIIO is in charge of HHS commercial health insurance programs, including the risk corridors program.
Drafters of PPACA created the program to encourage insurers to try selling insurance through the PPACA exchange program, and to encourage the participating insurers to price the coverage as cheaply as possible, by protecting them against the risk that claims could be higher than expected.
Originally, issuers thought HHS might pump in money if highly profitable issuers put in less money than expected, but HHS said it would try to run the program in a “budget neutral manner” and rely solely on insurer payments.
In December, Congress prohibited HHS from putting taxpayer money in the risk corridors programs. A court cited the new ban on federal risk corridors program funding in a liquidation order for a failed health plan, CoOportunity Health.