KP Comment

Kaiser Foundation Health Plan
Program Offices

September 3, 2015
William N. Parham, III,
Director, Paperwork Reduction Staff,
Office of Strategic Operations and Regulatory Affairs
Department of Health and Human Services
Hubert H. Humphrey Building,
200 Independence Avenue SW
Washington, DC 20201
Submitted electronically via www.regulations.gov
RE: Public Information Collection Requirements Submitted to the Office of Management
and Budget (OMB Control Number 0938–1155)
Dear Sir or Madam:
Kaiser Permanente provides comments to the Centers for Medicare and Medicaid Services
(“CMS”) in response to the “Public Information Collection Requirements Submitted to the
Office of Management and Budget” (OMB Control Number 0938–1155). 1 Kaiser Permanente is
the largest private integrated healthcare delivery system in the United States, delivering health
care to more than 10 million members in eight states and the District of Columbia. 2 We
participate in the individual and Small Business Health Options Program (“SHOP”) Marketplace
in each of the jurisdictions where we operate.
CMS has identified a number of significant discrepancies in the 2014 benefit year submissions
that issuers made for MLR and risk corridors on July 31, 2015. CMS requests approval of an
emergency revision to the risk corridors data validation information collection requirement. Each
company that submitted risk corridors data for the 2014 benefit year will be required to complete
and attest to a checklist which identifies critical components of the risk corridors and MLR
submission. CMS is also requiring select issuers justify the difference for reported claims or
premium amounts for risk corridors and MLR from data collected for the risk adjustment and
reinsurance programs. To complete this data verification, CMS calculated an additional annual
burden of 2,040 hours in total for 250 issuers.

1

80 Fed. Reg. 52478 (Aug. 31, 2015).
Kaiser Permanente comprises Kaiser Foundation Health Plan, Inc., the nation’s largest not-for-profit health plan,
and its health plan subsidiaries outside California and Hawaii; the not-for-profit Kaiser Foundation Hospitals, which
operates 38 hospitals and over 600 other clinical facilities; and the Permanente Medical Groups, independent
physician group practices that contract with Kaiser Foundation Health Plan to meet the health needs of Kaiser
Permanente’s members.

2

Government Relations
One Kaiser Plaza, 27th Floor
Oakland, CA 94612

Kaiser Permanente Comments
PRA Comments to CMS (OMB # 0938-1155)

After reviewing the supporting materials published by CMS, 3 we believe CMS grossly
underestimates the magnitude of the work associated with completing the checklist and
providing the methodology and written justifications for differences in the claims and premium
reports. CMS calculates the annual burden to be 8.13 hours per issuer. This approximation of
the burden is consistent with a high-level brief written justification of the claims and premium
difference.
Completing the MLR and Risk Corridors Submission Checklist (“Checklist”) and providing
supporting methodology and written justification to complete the Risk Corridors Discrepancy
Worksheet (“Worksheet”) will require significantly more time and resources. We expect the
burden to be at least 600-800 hours. To complete the Checklist and Worksheet, we have assigned
five employees full time for two weeks (400 - 500 hours) and assigned an additional five
employees part-time (200-300 hours). Even with these resources, we do not believe we are able
to complete the detailed allocations within the allotted time frame. We will submit the
information we have available by the September 14 deadline and continue performing
reconciliations beyond the submission date.
We understand CMS’ challenge of resolving data discrepancies. However, we are very
concerned that CMS’ compressed timeline to complete the checklist, put upon issuers with little
notice, will lead to incomplete or late submissions. Due to this burden, we request CMS allow
leniency in the deadline of submissions so issuers are able to accurately complete the data
request.
If you have questions or concerns, please contact Erica Pham at 510.271.6616 (email:
[email protected]) or me by phone or email at 510.271.6835 (email:
[email protected]).
Sincerely,

Anthony Barrueta
Senior Vice President, Government Relations
Kaiser Permanente

3

“Risk Corridors Data Validation for 2014 Plan Year,” CMS-10582 (Aug. 27, 2015). Available at:
https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.html
(accessed Sept. 3, 2015).

2