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Life Health > Health Insurance

Feds try to ease ACA subsidy program data agony

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Computer data matching problems caused nightmares for insurers trying to file 2014 and 2015 enrollee data for the Affordable Care Act cost-sharing reduction subsidy program.

Officials at the Centers for Medicare & Medicaid Services revealed just how painful the data filing problems were on Wednesday, in an explanation of new data requirement changes.

Related: PPACA three R’s programs: Insurers cry out

CMS started collecting detailed program enrollee data, for both 2014 and 2015, in June 2016. Insurers could choose whether to send CMS data prepared using a simplified method or a standard method, and 104 insurers picked the standard method.

The issuers using the standard method “resubmitted their data files an average of eight times before reaching a data file status that was acceptable for processing, and that included each policy for which the issuer wished to receive reimbursement,” officials write in the statement.

CMS says it’s hoping the changes it’s making will cut the average number of re-sends for the 2016 data to four, and reduce the overall amount of time spent on preparing and filing the data about 17 percent.

Back in November, CMS published a request for comments from the public about the cost-sharing reduction reporting process in the Federal Register.

Jeanette Thornton, a senior vice president at the Washington-based America’s Health Insurance Plans, told CMS to improve program technical support.

“CMS should have sufficient help desk support to respond to tickets in a timely manner during testing and production,” Thornton writes in a comment letter.

CMS held technical assistance calls for all issuers at least once per week last year, during the data file testing and submission system. The agency needs to do that again this coming year, Thornton said.

The federal Office of Management and Budget is supposed to review changes in federal efforts to collect information, to try to minimize the burden on the people or organizations providing the information.

CMS sent the new subsidy program data requirement changes to OMB for review Wednesday.

CMS is making the changes as agency officials are preparing to meet face-to-face with health insurance company executives. CMS will start a three-day meeting for plan issuers March 15, at its Baltimore headquarters. Many issuers have already announced plans to withdraw from the individual market in 2018, or expressed doubts about whether they will participate at all, given the uncertainty about what federal rules and programs will look like.

 House Republicans sued to block cost-sharing reduction subsidy program funding in November 2014. (Photo: Thinkstock)

House Republicans sued to block cost-sharing reduction subsidy program funding in November 2014. (Photo: Thinkstock) 

How the program works

The cost-sharing reduction program serves 4 million Affordable Care Act public exchange users who have family income under 250 percent of the federal poverty level.

The program helps the enrollees pay health plan deductibles, coinsurance amounts and co-payments.

CMS has been paying insurers a flat, estimated amount for each subsidy program enrollee since the exchange system came to life, in January 2014.

The 295 insurers getting the subsidy money knew they would eventually have to file reconciliation reports with CMS, to see whether they should get extra subsidy money from CMS, or pay excess subsidy money back to CMS.

The June reconciliation reports prepared using the standard method included the ID number for each enrollee, the enrollee’s claims, the amounts the insurer and the enrollee paid, and some other information.

CMS was supposed to use the enrollee ID number to validate an enrollee’s data, by comparing insurer records with ACA public exchange records. In many cases, CMS had trouble matching an enrollee ID number from an insurer with the corresponding enrollee ID number from an ACA exchange.

To try to prevent ID number matching problems, CMS will let insurers include three extra, optional data elements with the 2016 data files: the enrollee’s policy ID, the policy start date and the policy end date.

Court problems

CMS and insurers are wrestling with the cost-sharing reduction subsidy program data problems as some Republicans are trying to kill the program.

House Republicans sued to block funding for the program in November 2014. House Republicans argued at that the Obama administration was spending money on the program without a valid congressional appropriation.

Related: House Republicans sue Obama over ACA implementation

The Obama administration argued that the Affordable Care Act includes a permanent appropriation for the ACA premium tax credit program, and that the ACA tax credit appropriation applies to the cost-sharing reduction program, because the tax credit program and the cost-sharing reduction are two parts of the same program.

A district court judge ruled in favor of the House Republicans. The Obama administration appealed, and the appeal is still under review at the appellate level.

Related: plans with data woes face pay threat

Democrats defend ACA subsidy program funding

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