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September 18, 2015 at 01:49 PM
The Centers for Medicare & Medicaid Services (CMS) usually doesn’t get much of a response from the public when it puts new “information collection requirements” through the standard federal review process.
When CMS put an emergency addition to the data collection process for the new Patient Protection and Affordable Care Act (PPACA) “three R’s” risk-management programs through a review, health insurers howled.
Anthony Barrueta replied on behalf of Kaiser Permanente.
Matt Eyles of America’s Health Insurance Plans (AHIP) and Kris Haltmeyer of the Blue Cross and Blue Shield Association sent in a joint letter on behalf of the U.S. health insurer community.
CMS officials were supposed to give an estimate of how much time insurers would spend checking and explaining their three R’s data submissions, and the health insurer representatives strained to find ways to tell CMS how wrong they think the CMS burden estimates were.
“We believe CMS grossly underestimates the magnitude of the work associated with completing the checklist” and explaining what CMS sees as data problems, Barrueta writes in the Kaiser Permanente letter.
CMS and insurers are battling over the data submissions because drafters of PPACA created three huge new programs for insurers — a temporary reinsurance program, a permanent risk-adjustment program, and a temporary risk corridors program — in effort to protect insurers against the risk that giant, unexpected, PPACA-related swings in claims risk would kill commercial health insurers.
See also: Feds: “We’ll send some PPACA lifeboat money in December”
CMS is using a broad insurer fee to fund the reinsurance program, but the risk-adjustment program requires insurers with enrollees with low risk scores to send cash to competitors with enrollees with high risk scores, and the risk corridors program requires insurers with good underwriting results to send cash to competitors with poor underwriting results.
See also: What if CMS risk-adjustment bill collectors fail?
CMS has been using different types of data to run each program and it required high-level health insurance company executives to attest to the completeness and accuracy of the data submitted. But CMS officials reported in August that the differences between the data reports insurers filed for each of the three R’s are so great that it will require many insurers to go through a long checklist to verify the data, verify that the information is correct, and explain why what CMS is seeing as discrepancies exists. The data validation reports were due Sept. 14.
CMS has published preliminary three R’s data in ways that make it difficult to analyze how three R’s problems could affect insurers, but officials seem to have hinted that the impact could be big enough to do significant harm to some insurers’ finances.
For more details about what insurers are saying about the data discrepancy fight, read on.
