Close Close
Popular Financial Topics Discover relevant content from across the suite of ALM legal publications From the Industry More content from ThinkAdvisor and select sponsors Investment Advisor Issue Gallery Read digital editions of Investment Advisor Magazine Tax Facts Get clear, current, and reliable answers to pressing tax questions
Luminaries Awards

Regulation and Compliance > Federal Regulation plans with data woes face pay threat

Your article was successfully shared with the contacts you provided.

The Centers for Medicare & Medicaid Services (CMS) may hold cash back from 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 to begin using the automated system to file their policy reports in January.

See also: 3 ways the PPACA data filing mess makes insurers want to SCREAM

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 issuer user fee payments. Up till now, carriers have been sending CMS the required information using spreadsheets.

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.

See also: PPACA risk programs: Will those kidneys work?

CMS will start by having issuers file policy reports both through the manual process and the new automated process, according to officials at the Center for Consumer Information & Insurance Oversight (CCIIO), the CMS division in charge of the public exchange program. 

If an issuer is having problems with filing acceptable automated policy reports from April through June, CMS will withhold 25 percent of the total amount it expects to pay the issuer until the issuer starts using the automated filing system, CCIIO officials say in a bulletin.

If an issuer is still having automated filing problems, CMS will withhold 50 percent of the total amount it expects to pay the issuer until the issuer starts using the automated filing system.

“If non-compliance continues over an extended period of time, CMS will determine the need for further proration or compliance actions,” CCIIO officials say. “We note that issuers with advance payments withheld may not require consumers to pay additional premiums or cost-sharing to recoup withheld payments.”

Are you following us on Facebook?


© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.