While conducting program integrity
reviews of submitted data for the 2014 benefit year, CMS has
identified a number of material differences in the 2014 benefit
year submissions that issuers made for MLR and risk corridors on
July 31, 2015, compared with other data available to CMS, including
data submitted through the EDGE servers. CMS also identified a
number of common errors that may lead to submissions that do not
comply with CMS regulations and guidance. In order to investigate
these material differences and operate the MLR and risk corridors
program accurately and effectively, CMS seeks to quantify the
impact of claims and premium differences by collecting information
on the dollar value of, and written explanations of, these
differences. This information is not included in the risk corridors
data validation ICR that is currently approved under OMB Control
Number 0938-1155. "Standards Related to Reinsurance, Risk
Corridors, Risk Adjustment, and Payment Appeals", which only
estimates the burden for QHP issuers to review and validate their
risk corridors data. Without additional information, CMS will be
unable to verify the accuracy of the submission and validate the
data needed to operate the MLR or risk corridors programs.
CMS has set forth data
validation procedures for the risk corridors program at 45 CFR
153.530-540. While conducting program integrity reviews of
submitted data for the 2014 benefit year, CMS has identified a
number of material differences in the 2014 benefit year submissions
that issuers made for MLR and risk corridors on July 31, 2015,
compared with other data available to CMS, including data submitted
through the EDGE servers. CMS also identified a number of common
errors that may lead to submissions that do not comply with CMS
regulations and guidance. In order to investigate these material
differences and operate the MLR and risk corridors program
accurately and effectively, CMS seeks to quantify the impact of
claims and premium differences by collecting information on the
dollar value of, and written explanations of, these differences.
This information is not included in the risk corridors data
validation ICR that is currently approved under OMB Control Number
(OCN) 0938-1155. “Standards Related to Reinsurance, Risk Corridors,
Risk Adjustment, and Payment Appeals”, which only estimates the
burden for QHP issuers to review and validate their risk corridors
data. Without additional information, CMS will be unable to verify
the accuracy of the submission and validate the data needed to
operate the MLR or risk corridors programs. Therefore, CMS is
requesting emergency clearance of this ICR by the Office of
Management and Budget by September 4, 2015. Verifying the accuracy
of the MLR and risk corridors data is critical to CMS’s mission of
ensuring the integrity of these programs. If data is not validated,
public harm could result because premium uncertainty in the
individual and small group health insurance markets would increase,
and rebates to consumers could be inaccurate. CMS is requesting a
revision to the ICR under emergency procedure in order to provide
for the timely implementation of risk corridors payments and
charges. A delay in these payments and charges could influence
issuers’ ability to comply with the regulatory deadline for MLR
rebates set forth at 45 CFR 158.240(d), rate setting and other
regulatory decisions by Departments of Insurance and Exchanges, and
the statutory accounting treatment of risk corridors
receivables.
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.
CMS-10582 Response_to_Public_Comments (9-4-15).doc
CMS-10582 EMERGENCY KP Comment Letter Risk Corridors PRA 09 2015.pdf
CMS-10582 - RC Letter Discrepancy #2 WAD.docx
MLR Risk Corridors Submission Checklist and the Risk Corridors Data Discrepancy Worksheet