May 18 -- The Centers for Medicare & Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS' intention to collect CMS–10401 Standards Related to Reinsurance, Risk Corridors, and Risk Adjustment. Comments are due by July 17, 2023.
The data collection and reporting requirements will be used by HHS to run the permanent risk adjustment program, including validation of data submitted by issuers, on behalf of States that requested HHS to run it for them. Risk adjustment is one of three market stability programs established by the Patient Protection and Affordable Care Act and is intended to mitigate the impact of adverse selection in the individual and small group health insurance markets inside and outside of the Health Insurance Exchanges. HHS will also use this data to adjust the payment transfer formula for risk associated with high-cost enrollees. Issuers and providers can use the alternative reporting requirements for mental and behavioral health records described herein to comply with State privacy laws.
Section 1341 of the ACA provides that each state must establish a transitional reinsurance program to help stabilize premiums for coverage in the individual market during the first three years of Exchange operation. Section 1343 provides for a program of risk adjustment for all non-grandfathered plans in the individual and small group market both inside and outside of the Exchange. Sections 1402 and 1412 of the ACA establish a program for reducing cost sharing for individuals with lower household income and Indians. Sections 1401 and 1411 of the ACA provide for advance payments of the premium tax credit for low- and moderateincome enrollees in a qualified health plan (QHP) through an Exchange.
Section 1321(a) also provides broad authority for the Secretary to establish standards and regulations to implement the statutory requirements related to Exchanges, reinsurance, risk adjustment, and other components of title I of the ACA. These risk-spreading and insurance
affordability programs, which will be implemented by HHS or states, are designed to mitigate adverse selection, to provide stability for health insurance issuers in the individual and small group markets as market reforms and Exchanges are implemented, and to make health
insurance more affordable and accessible to millions of Americans who currently do not have affordable options available to them.
The data collection and reporting requirements described below will enable states, the District of Columbia, and HHS to implement these programs, which will mitigate the impact of adverse selection in the individual and small group markets both inside and outside the Exchange.
Affected Public: State, local, or Tribal governments;
Number of Respondents: 650
Draft survey instrument and supporting documentation: https://www.cms.gov/regulations-and-guidance/legislation/paperworkreductionactof1995/pra-listing-items/cms-10401