The Centers for Medicare & Medicaid Services (CMS) may hold cash back from HealthCare.gov exchange plan issuers that fail to send it complete, accurate policy reports for 2016 coverage through a new automated intake system.
CMS wants the carriers that sell coverage through HealthCare.gov to begin using the automated system to file their policy reports in January.
The automated reports are supposed to provide the information CMS uses to compute Patient Protection and Affordable Care Act (PPACA) advance premium tax credit (APTC) subsidy payments, PPACA cost-sharing reduction (CSR) subsidy payments and HealthCare.gov issuer user fee payments. Up till now, carriers have been sending CMS the required information using spreadsheets.
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CMS officials are hoping the shift to automated reporting system will increase the accuracy of the information they’re getting, reduce administrative costs, and help them spot exchange system trends and problems more quickly.