Response to 60-day comments

Response to Public Comments Received for CMS-10401
HHS received one comment from Health Alliance Plan of Michigan in the 60-day comment
period for the revision of the Paperwork Reduction Act Submission: Standards Related to
Reinsurance, Risk Corridors, Risk Adjustment, and Payment Appeals (CMS-10401/OMB
Control Number 0938-1155).
Comment: Health Alliance Plan of Michigan recommends that the new data elements described
in the Supporting Statement be implemented as “‘soft’ edits for the first year of implementation”,
which they argue will “help to avoid potential enrollment rejections and the exclusion ‘aka,
orphan status’ of enrollees who should be considered as part of the risk adjustment calculation”.
Response: While HHS appreciates the commenter’s request to implement a transitional period
for the new data elements described in the PRA, the implementation timeline was previously
addressed in the HHS Notice of Benefit and Payment Parameters for 2023 final rule (“2023
Payment Notice,” 87 FR 27208) and the HHS Notice of Benefit and Payment Parameters for
2024 final rule (“2024 Payment Notice,” 88 FR 25740). As a result of this comment, HHS
provided more background information in the Supporting Statement on the implementation
timeline of the six new data elements, as finalized in the 2023 Payment Notice and 2024
Payment Notice.
As described in the 2023 Payment Notice, beginning with the 2023 benefit year, issuers will be
required to populate the ZIP Code and subsidy indicator fields as part of their EDGE data
submissions. Issuers will also be required to populate the race, ethnicity, and Individual
Coverage Health Reimbursement Arrangement (ICHRA) indicator fields. For the 2023 and 2024
benefit years, HHS adopted a transitional period for the race, ethnicity, and ICHRA indicator
fields, during which time issuers will be required to populate these fields using available data
sources. Then, beginning with the 2025 benefit year, issuers that do not have an existing source
to populate these fields for particular enrollees will be required to make a good faith effort to
collect and submit race, ethnicity, and ICHRA indicator data elements for these enrollees.
As described in the 2024 Payment Notice, HHS finalized the proposal to collect and extract a
Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) indicator. HHS also
finalized the adoption of a transitional approach for collecting the QSEHRA indicator under
which issuers will be required to populate this new QSEHRA indicator using data they already
have or collect for the 2023 and 2024 benefit years. Then, beginning with the 2025 benefit year,
issuers will be required to populate the field using available sources and, in the absence of an
existing source to populate the QSEHRA indicator for particular enrollees, issuers will be
required to make a good faith effort to ensure collection of this data element.
Beginning with the 2023 benefit year data submissions, issuers must submit the EDGE
Enrollment File in the updated file format as provided by CMS, which includes the new data
elements. Failure to submit Enrolment Files using the updated file format or failure to submit
Enrollment Files in accordance with file ingest rules will result in rejection of enrollment
records. The EDGE Enrollment File format and file submission rules will be updated in
September 2023 to accommodate ingest of the new data elements.

CMS is providing issuers with flexibility to ensure that issuer’s data is not inappropriately
rejected and/or claims orphaned. For more technical information about the EDGE data
submission requirements, please refer to the documentation published in the REGTAP document
library (www.regtap.cms.gov).