SPECIAL NOTICE
R -- Request for Information Regarding the Reinsurance Program under the Affordable Care Act
- Notice Date
- 12/16/2011
- Notice Type
- Special Notice
- NAICS
- 524298
— All Other Insurance Related Activities
- Contracting Office
- Department of Health and Human Services, Centers for Medicare & Medicaid Services, Office of Acquisition and Grants Management, 7500 Security Blvd., C2-21-15, Baltimore, Maryland, 21244-1850
- ZIP Code
- 21244-1850
- Solicitation Number
- HHS-CMS-DBSC-RFI-11-621
- Archive Date
- 2/16/2012
- Point of Contact
- Brian J Humes, Phone: 410-787-8898
- E-Mail Address
-
brian.humes@cms.hhs.gov
(brian.humes@cms.hhs.gov)
- Small Business Set-Aside
- N/A
- Description
- Request for Information Regarding the Reinsurance Program under the Affordable Care Act BACKGROUND: This notice is a request for information (RFI) to gain market information on entities that could administer a transitional reinsurance program. This RFI is not a Request for Proposals (RFP). The Affordable Care Act (ACA) provides that each State must establish a transitional reinsurance program to help stabilize premiums for coverage in the individual market during the first three years of Exchange operation (2014-2016). On July 15, 2011, the Departments of Health and Human Services (CMS) published a proposed rule regarding the reinsurance program and other premium stabilization components of the ACA. The proposed rule provides standards to States establishing or contracting with a not-for-profit reinsurance entity responsible for carrying out the transitional reinsurance program, including collecting reinsurance contributions from issuers and third-party administrators, and calculating and disbursing reinsurance payments to eligible individual market issuers. This RFI solicits information about entities that could function as a reinsurance entity for the transitional reinsurance program. CMS or one or more States may contract for services required to fulfill the statutory and regulatory requirements of the reinsurance entity. DATES: Submit written or electronic comments by 4:00 PM ET on January 16, 2012. We note that responses to this RFI are not offers, and cannot be accepted by the Government to form a binding contract or to issue a grant. The purpose of this RFI is to gather public comments on the proposed rules for reinsurance, risk corridors, or risk adjustment under the ACA. Those comments have been collected and are being evaluated separately. Information obtained in response to this RFI may be used by the Government for program planning and development, or other purposes with or without attribution. Do not include any information that might be considered proprietary or confidential. Section 1341 of the ACA provides that each State must establish a transitional reinsurance program to help stabilize premiums for coverage in the individual market during the first three years of Exchange operation (2014-2016). The reinsurance program, which is a State-based program, will reduce the uncertainty of insurance risk in the individual market by making payments for high-cost cases. This program will attenuate individual market rate increases that might otherwise occur because of the immediate enrollment of individuals with unknown health status, potentially including, at the state's discretion, those currently in state high-risk pools. CMS published proposed rules for states and health insurance issuers for this reinsurance program on July 15, 2011 at 76 FR 41930. Section 1321(c) (1) authorizes the Secretary of the Department of Health and Human Services to implement the reinsurance program and other components of title I of the Affordable Care Act in states that have not done so. The statute also requires that each State, or CMS on behalf of the State, establish or contract with an entity to carry out the reinsurance program. The reinsurance entity must be a not-for-profit organization with a tax-exempt status. QUESTIONS: This RFI seeks comment on the entities that could carry out the transitional reinsurance program. CMS may enter into one or more contracts to fulfill the statutory and regulatory requirements of the transitional reinsurance program established under section 1341 of the ACA depending on the workload and number of States that would require assistance. In such a case, the contractor may be tasked with one or more of the following functions: • collecting reinsurance contributions; • accepting and validating requests for reinsurance payments; • remitting reinsurance payments; • reconciling and verifying reinsurance contributions and payments • maintaining records; and, • providing customer support to issuers. CMS is seeking to engage formally, in a transparent and participatory manner, with entities that understand the reinsurance market, and would be able to perform the responsibilities of a reinsurance entity under the statute and associated regulations. In carrying out the transitional reinsurance program, CMS seeks to mitigate conflicts of interest (COI) that may arise if potential market competitors operate the reinsurance program. As such, we request any information on potential COIs, and potential avenues for mitigation, from all stakeholders, including issuers and third-party administrators. Infrastructure Questions (1) Does your organization operate as a not-for-profit reinsurance entity in the state(s) in which you currently conduct business? (2) If your organization operates as a reinsurance entity but does not function as a not-for-profit, what steps would have to be taken to convert the organization or the part of that organization responsible for reinsurance operations into a not-for-profit entity? What other considerations should be taken into account in connection with such a conversion? (3) What other steps must your organization take in order to be prepared to smoothly transition into a role as administrator of a new temporary reinsurance program? (4) Does your organization operate nationally or in limited geographic areas? If the latter, what are the geographic areas? (5) Would your organization be able and willing to contract with a State and/or the Federal government to operate a temporary reinsurance program? (6) Are there any State and/or local licensing requirements that must be considered by an organization operating as such a reinsurance entity? (7) What potential conflicts of interest (COI) could arise if your organization were to operate such a reinsurance program as a not-for-profit entity? How might these COIs be mitigated? (8) For organizations that do not currently have COI mitigation programs, what steps would have to be taken to develop and execute such a program? (9) What is a reasonable amount of time for your organization to become fully operational (e.g., have all systems in place to operate a reinsurance program) after the date of a contract award? What resources would be necessary? Collection and Disbursement of Reinsurance Funds Questions (10) Describe your organization's ability to perform the following functions: • collecting reinsurance contributions; • accepting and validating requests for reinsurance payments; • remitting reinsurance payments; and, • reconciling and verifying reinsurance contributions and payments. (11) What services related to the collection of reinsurance contributions, or disbursement of reinsurance payments to another entity would your organization need to subcontract due to a lack of capacity, expertise, or experience? (12) What COIs could arise for such potential subcontractors? Data Collection Questions (13) Describe current data systems that are used by your organization, including any standards, security systems, and web-based interactive structure. Are your systems compliant or have the capability of being Section 508 compliant <http://www.section508.gov/>? (14) Do your organization's current data systems have the capability to interface with external systems to accept data and reports? If yes, what types of interfaces are currently in place? (15) What data are currently collected by your organization related to medical costs? (16) What is your organization's current capacity for collecting and verifying claims submissions from issuers? What processes does your organization have in place to ensure confidentiality and security protections of patient information? (17) In what formats does your organization currently collect data? Can your organization support other formats? If so, which ones? (18) Would your organization need to subcontract any services related to data collection? (19) What COIs could arise for such subcontractors? Customer Support Questions (20) What telecommunication and technical support systems does your organization currently maintain for health insurance issuers or other commercial clients (e.g., websites, 24-hour hotlines, helpdesk)? (21) Are your support systems compliant or have the capability of being Section 508 compliant <http://www.section508.gov/>? (22) Would your organization need to subcontract any services related to data collection? (23) What COIs could arise for such subcontractors? Evaluation Questions (24) Does your organization currently conduct evaluations of operations and activities? Do such evaluations include a financial assessment of your organization's activities? (25) What are your organization's current financial and data reconciliation processes? Please submit all written responses to: Centers for Medicare & Medicaid Services Attn: Brian Humes, Contract Specialist Office of Acquisitions and Grants Management Acquisitions and Grants Group Division of Beneficiary Support Contracts Mailstop: C3-30-03 7111 Security Boulevard Baltimore, MD 21244 Point of Contact Name: Brian Humes, Contract Specialist Phone: 410-786-8898 Email: brian.humes@cms.hhs.gov Please note, CMS is not taking questions for this RFI.
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