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Feds setting up new exchange plan reporting system

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The Centers for Medicare & Medicaid (CMS) says it’s still working on major new health insurance plan reporting requirements.

CMS, part of the U.S. Department of Health and Human Services (HHS), announced today in a paperwork review notice published in the Federal Register that it has asked the Office of Management and Budget (OMB) for a control number for a new effort to collect information from health insurers.

Section 1311(e)(3) of the Patient Protection and Affordable Care Act of 2010 (PPACA) requires issuers of the qualified health plans (QHPs) sold through PPACA public exchanges to post information about enrollment, claim denials, finances, claim payments, out-of-network coverage arrangements and other matters in a standardized format.

See also: Feds designing PPACA plan hole analyzer

In November 2014, CMS began putting an exchange plan issuer reporting template through a paperwork review process, but the agency put off actually requiring the issuers to send in the reports.

Although HHS, the parent of CMS, will start by applying new reporting rules to exchange plan issuers, HHS “intends to phase in implementation for other entities over time,” CMS says. 

HHS will work with the U.S. Department of Labor and the U.S. Treasury Department to develop the reporting requirements for the other entities through a separate process, CMS says.

The new requirements will apply to non-grandfathered group health plans, including non-grandfathered self-insured plans, and to insurers selling group and individual insurance coverage outside the exchange system, CMS says.

The reporting rules for non-QHP issuers may be different from the rules for the QHP issuers, and the departments want to make the reporting rules for non-QHP issuers as streamlined as possible, CMS says.

The departments will implement the non-QHP reporting rules “only after notice and comment, and after giving those issuers and plans sufficient time…to come into compliance with those requirements,” CMS says.

CMS lists Valisha Price as the contact for the paperwork review notice.

In a separate, but similar, answer to frequently asked questions (FAQs) about PPACA implementation, the departments say they will propose the reporting requirements for non-QHP issuers “in the future.”

See also: PPACA data inflation prompts HHS chief to demand review