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CMS Seeks Emergency Clearance on Insurance Info Request

By Kerry Young, CQ Roll Call

August 28, 2015 -- The Centers for Medicare and Medicaid Services (CMS) is seeking an emergency review of its request to collect more information from health insurance companies in connection with the medical loss ratio data and risk corridor regulations, which both are part of the agency's effort to fully implement the Affordable Care Act (ACA).

That law compels insurers to submit data on the proportion of premium revenues spent on medical services and quality improvement program, referring to this spending as the medical loss ratio (MLR), according to a general explanation on the CMS' web site. Companies that exceed certain limits then have to issue rebates. The risk corridor program is part of the incentives and support provided to the insurance industry through the 2010 law, which seeks to broaden the number of Americans who have medical coverage.

CMS found a "number of significant discrepancies in the 2014 benefit year submissions that issuers made for MLR and risk corridors on July 31, 2015," the agency said in a document filed with the Federal Register Thursday afternoon. CMS officials said in the filing that they are concerned that the agency "will be unable to verify the accuracy of the submission and validate the data needed to operate the MLR or risk corridors programs" if it doesn't get additional information.

"Based on CMS's identification of more significant data discrepancies than previously anticipated, we are requesting an emergency revision to the risk corridors data validation information collection requirement," CMS said in the filing.

CMS is seeking to modify information collection procedures currently approved by the Office of Management and Budget. The Thursday filing makes a request for public comment on this request for emergency clearance, giving interested parties until Sept. 3 deadline to make submissions.

CMS on Aug. 7 had said it found "a significant number of discrepancies" while reviewing the submitted risk corridor data. "CMS previously indicated its intention to publish preliminary estimates of program-wide payments and charges for the risk corridors program on August 14, 2015," CMS said on Aug. 7. "In order to allow for a full validation of these data discrepancies, we are postponing the publication of the preliminary risk corridors program results at this time."

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