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The Centers for Medicare and Medicaid Services plans to develop verification data and services to support coverage and eligibility infrastructure for health insurance exchanges and seeks industry information about applications that are available.
A solution that verifies eligibility for qualifying coverage in an employer-sponsored plan is part of the process for determining whether an individual qualifies for advance payment of the premium tax credit that is available to support the purchase of health plans through the exchanges.
CMS wants to identify authoritative data sources that can be used or adapted to meet the verification requirement and also how to develop new data sources that could fulfill that condition, according to an April 30 announcement for request for information in Federal Business Opportunities. Responses are due May 21.
Among solutions that the Health and Human Services Department has proposed in a rule describing health insurance exchanges is development of a database that contains authoritative data to assure employer-sponsored coverage.
The Patient Protection and Affordable Care Act did not require this data, so population of a potential database would be voluntary. And no data sources currently exist that contain comprehensive information about access to employer-sponsored coverage or the affordability and minimum value of such coverage, according to the notice.
Under the health reform law, states must have operational capability of their online marketplace to compare and purchase health coverage by October 2013.
One example of how verification might work is that an exchange could use a database to check applicant attestations about access to employer-sponsored coverage. A business service request generated by the exchange would check private and public data sources through a CMS data services hub to confirm the accuracy of the data that was submitted. These data sources could include the state Directory of New Hires or state quarterly wage databases.
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CMS also seeks information about technology or business process applications that can verify the current income of individuals and households seeking insurance through the qualified health plans offered through the exchange, according to an April 23 request for information. The process is similar to that for verification for employer-sponsored coverage and the use of a CMS data services hub to confirm data. Responses are due May 14.
Exchanges must be able to determine also whether individuals are eligible to receive advance payments of the premium tax credit, cost-sharing reductions and exemptions from the individual responsibility requirement. Income levels are available from individual confirmation and data from federal, state and commercial sources.
Processes for eligibility and income verification need to be streamlined and coordinated across HHS, the exchanges, state Medicaid and Children’s Health Insurance Program agencies. Yet the information required from an applicant must be the minimally necessary to support eligibility and enrollment procedures across those programs.