Public Comments - AHIP

January 3, 2014
Comments Submitted Electronically at: http://www.regulations.gov
Center for Medicare and Medicaid Services
Office of Strategic Operations and Regulatory Affairs,
Division of Regulations Development,
Room C4–26–05,
7500 Security Boulevard, Baltimore,
Maryland 21244–1850.
Attention: Document Identifier/OMB Control Number CMS-10418
Re:

Annual MLR and Rebate Calculation Report and MLR Rebate Notices
Form Number: CMS–10418
AHIP Supplemental Comments to our Comments on December 19 on the Draft 2013
Instructions and Forms

Dear Ms.McCune,
America’s Health Insurance Plans (AHIP) appreciates the opportunity to provide these additional
comments to supplement our comments submitted December 19, 2013 on the materials in the
PRA Information Collection Request published in the Federal Register November 22, 2013.
AHIP is the national trade association representing the health insurance industry, with members
providing health and supplemental benefits to more than 200 million Americans through
employer-sponsored coverage, the group and individual insurance markets, and public programs
such as Medicare and Medicaid.
Based on further review and discussion with our member plan experts, we have the following
additional comments and recommendations:
ACA Fees Collected in 2013 - We very much appreciate the guidance issued i on December 30,
2013 which addresses premiums collected for 2014 ACA assessments on non-calendar year policies.
during 2013 in 2013 MLR and rebate reporting. It notes that for the 2013 MLR reporting year,
issuers may defer including in their MLR and rebate calculations the portion of 2013 premiums
collected for 2014 ACA assessments or fees on non-calendar year policies. If issuers elect to defer
this portion of premium in the 2013 MLR and rebate calculations, they must disclose the deferred
amount for each respective state and market. In addition, issuers must disclose and reduce the MLR
tax adjustment to premium by the amount of federal and state taxes and fees associated with the
deferred portion of premium.

January 3, 2014
CMS-10418
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We also strongly recommend that this be the standard for treatment of the ACA portion of issuer fees
collected in the data year of calendar-year policies moving forward in the MLR calculation
methodology.

PCORI Fee treatment - For the PCORI fee treatment in Section 3 - 3.1b the instructions state
“PCORI fees paid related to applicable policies during the MLR reporting year,” but we ask if
this is intended. It would suggest that PCORI would not have been covered under the CY2012
MLR, since that payment was made in 2013, not 2012. We recommend that language be added
to refer to "or attributed to.”
Clarification on this point is requested since the PCORI reporting instruction last year, under the
CY2012 MLR instructions, may have led issuers to include accrued PCORI fees, which the CY2013
MLR instructions now appear to call for reporting on a cash basis only.

CY2013
Line 3.1 – Federal taxes and assessments incurred by the reporting issuer during the MLR
reporting year
3.1a – Federal income taxes deductible from premiums in MLR calculations
Include: Federal income taxes attributed to the MLR reporting year allocated to the
respective lines of business reported.
Exclude: Federal income taxes on investment income and capital gains.
3.1b – Patient Centered Outcomes Research Institute (PCORI) Fee
This fee is imposed on an issuer of a specified health insurance policy and a plan
sponsor of an applicable self-insured health plan.
Include: PCORI fees paid related to or attributed to applicable policies during the
MLR reporting year.

PCORI Schedule
Calendar year

2012
2013

2014

Applicable Policies
(based on policies end
date)
Oct. 1 to Dec. 31, 2012
Jan. 1 to Sept. 30, 2013
&
Oct. 1 to Dec. 31, 2013
Jan. 1 to Sept. 30, 2014

Corresponding Fee

Payment Due

$1 per covered life
$1 per covered life
&
$2 per covered life
$2 per covered life

July 31, 2013
July 31, 2014

July 31, 2015

January 3, 2014
CMS-10418
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&
Oct. 1 to Dec. 31, 2014
2015

Jan. 1 to Sept. 30, 2015
&
Oct. 1 to Dec. 31, 2015

2016

Jan. 1 to Sept. 30, 2016
&
Oct. 1 to Dec. 31, 2016

&
$2 (+ 2014 NHE %-based
increase) per covered life
$2 (+ 2014 NHE %-based
increase) per covered life
&
$2 (+ 2015 NHE %-based
increase) per covered life
$2 (+ 2015 NHE %-based
increase) per covered life
&
$2 (+ 2016 NHE %-based
increase) per covered life

July 31, 2016

July 31, 2017

We note that we were unable to provide robust comments on the spreadsheet provided, as it did
not include the formulas/macros, (as was provided for the 2012 reporting). We will be happy to
review them for consistency with the MLR and Rebate Report Draft Instructions
We would be happy to discuss any of these comments with you, or provide further information
as needed.
Thank you.
Sincerely,

Colleen M. (Candy) Gallaher
Senior Vice President - State Policy
cc: William Weller, OmegaSquared - Consultant to AHIP
i

http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/mlr-guidance-aca-fees-carveout2013-12-30.pdf