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Life Health > Health Insurance

CCIIO posts health plan filing dates

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Health insurers in many states will have to file major medical rates for 2016 before they know how the three Patient Protection and Affordable Care Act (PPACA) risk-management programs really work.

Officials at the Center for Consumer Information & Insurance Oversight (CCIIO) have given the insurers a summary of the PPACA rate review and risk-management program rules and calendars in two new batches of guidance.

CCIIO is a unit of the Centers for Medicare & Medicaid Services (CMS), which, in turn, is a unit of the U.S. Department of Health and Human Services (HHS). CCIIO runs the PPACA exchange programs in many states, and it runs PPACA rate review programs in many states.

The U.S. Supreme Court may hand down a ruling on King vs. Burwell (Case Number 14-114), a case that could have a major effect on individual market pricing in some states, in late June.

CCIIO says it will start giving insurers details about the payments and charges stemming from the PPACA temporary reinsurance program, the PPACA temporary risk corridors program and the PPACA permanent risk-adjustment program — three PPACA programs that could have a major effect on pricing — this summer.

The reinsurance program is supposed to help PPACA-compliant plans pay the bills of enrollees with catastrophic claims in 2014, 2015 and 2016. The risk corridors program is supposed to use cash from issuers with good underwriting results in those three years to help issuers with bad underwriting results. The risk-adjustment program is supposed to use cash from plans with low-risk enrollees to help plans with high-risk enrollees. 

CCIIO notices showing how much issuers will get, or pay, the risk-adjustment and reinsurance programs for the 2014 plan year are supposed to go out by June 30.

See also: Feds post PPACA reinsurance program data

Notices showing CCIIO’s preliminary risk corridors program transfer calculations are supposed to go out Aug. 14.

CCIIO hopes to make risk-adjustment and reinsurance program payments from July through September, and it hopes to make risk corridors program payments from September through December.

See also: Risk corridors battleground emerges

But, in many states, CCIIO says, insurers will have to file 2016 major medical design and rate information this spring.

In some states, state regulators run the exchange system, handle rate reviews, or both. State regulators in those states may be able to adjust filing calendars.

CCIIO officials could eventually adjust CCIIO’s own deadlines.

But, if the current schedule sticks in the CCIIO-run states, insurers in those states must file applications for 2016 exchange plans, or qualified health plans (QHPs), from April 15 to May 15. The insurers in those states must file rates for all individual plans, including QHPs and off-exchange products, by May 15.

CCIIO is supposed to post information about any requests for rate increases of 10 percent or greater by June 1. CCIIO is supposed to have final rate information in its rate system for QHPs by Aug. 25 and for other individual plans by Oct. 9.


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