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CMS Announces ACA Transitional Reinsurance Fee for 2016

On November 21, 2014, the U.S. Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) released proposed regulations in the form of the 2016 Notice of Benefit and Payment Parameters. The proposed regulations address a number of issues, including the transitional reinsurance program (TRP) fee.

Under Section 1341 of the Patient Protection and Affordable Care Act (PPACA), during the first three years that state health insurance exchanges are operational (2014 through 2016), health insurance issuers and plan administrators (on behalf of self-insured group health plans) will be assessed a per-enrollee fee to finance a three-year transitional reinsurance program. 

The contribution rate for 2015 is $44 per covered life; it was $63 per covered life for 2014.  The proposed regulations set the TRP fee at $27 per enrollee for the 2016 benefit year. 

The regulations also include additional information on the exception for certain self-administered, self-insured group health plans, clarifications regarding certain counting methods, and guidance regarding the deadline for satisfying reporting requirements where the reporting date does not fall on a business day. Specifically:  

Self-administered, self-insured plan exception: For the 2015 and 2016 benefit years, a "covered entity" does not include qualifying self-administered, self-insured group health plans. In the preamble to the 2015 Notice of Benefit and Payment Parameters, HHS indicated that it considered a third party administrator to be an entity that is not under common ownership or control with the self-insured group health plan or its plan sponsor. The preamble to the proposed regulations states that principles similar to the controlled group rules of Code sections 414(b) and (c) would apply for purposes of determining whether a third-party administrator is under common ownership or control with a plan or its plan sponsor.

Snapshot Count and Snapshot Factor Counting Methods: The proposed regulations clarify the application of the snapshot count and snapshot factor counting methods to a health insurance plan or coverage that is established or terminated, or that changes funding mechanisms, in the middle of a quarter. The proposed regulations provide that, if the plan or coverage in question had enrollees on any day during a quarter and if the contributing entity uses either the snapshot count or snapshot factor method, it must choose a set of counting dates for the counting period such that the plan or coverage has enrollees on each of the dates, if possible. However, the enrollment count for a date during a quarter in which the plan or coverage was in existence for only part of the quarter can be reduced by a factor reflecting the amount of time during the quarter for which the plan or coverage was not in existence.

Reporting Deadlines: The proposed regulations would require a contributing entity to submit its annual enrollment count for the applicable benefit year to HHS no later than November 15 of benefit year 2014, 2015, or 2016, or, if such date is not a business day, the next business day. 

Posted by Cristie Travis at 7:13 AM

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