Smart Benefits: HHS to Up Investigations of Exchanges
Monday, March 16, 2015
According to the 2015 work plan of the Department of Health and Human Services (HHS) Office of Inspector General, health insurance marketplaces are one of its top three priorities for 2015.
Among HHS’ charges from the ACA is increasing access to health insurance for those who are eligible for coverage, improving access to and the quality of health care, and lowering health care costs and increasing value for taxpayers and patients – and OIG will review its progress toward those goals this year.
More Reviews
GET THE LATEST BREAKING NEWS HERE -- SIGN UP FOR GOLOCAL FREE DAILY EBLASTAs part of its efforts, OIG plans to initiate at least five to ten additional reviews addressing ACA programs that will focus on emerging marketplace issues, such as potential vulnerabilities that may arise in connection with the second open enrollment period; implementation of additional marketplace functionality, such as the redetermination process; and the premium stabilization programs.
Continued Oversight
In addition to the increased number of reviews, OIG’s 2015 oversight strategy for the marketplaces will continue to focus on proper expenditure of taxpayer funds and the efficient and effective operation of the marketplaces, including:
Payments: OIG will focus on whether taxpayer funds are being expended correctly for their intended purposes, evaluating:
The accuracy of aggregate payments to qualified health plan issuers for advance premium tax credits and cost sharing reductions
The accuracy of advance premium tax credits and cost sharing reductions payments for individual enrollees
CMS’s internal controls over advance premium tax credit obligations and payments under the Affordable Care Act
Programmatic justification for CMS’s involvement in premium tax credit obligations under the Affordable Care Act
Review of Affordable Care Act establishment grants for state marketplaces
Eligibility: To determine whether the right people are getting the right benefits, OIG will review:
Affordable Care Act enrollment safeguards at additional state marketplaces
The federally facilitated marketplace’s eligibility verifications for premium tax credits
Inconsistencies in the federally facilitated marketplace applicant data
Management and Administration: OIG will review HHS’ efficiency and effectiveness in managing
and administering the marketplace programs, including:
Implementation of the federally facilitated marketplace
Oversight of federally facilitated marketplace contractors
Security: OIG will assess whether consumers’ personal information is safe by reviewing:
CMS’s implementation of security controls over consumer information obtained in the federally facilitated marketplace
State-based marketplaces’ information system security controls
Rob Calise is a founding partner of Cornerstone Group, where he helps clients control the costs of employee benefits by focusing on consumer driven strategies and on how to best utilize the tax savings tools the government provides. Rob serves as Chairman of the Board of United Benefit Advisors, and is a board member of the Blue Cross & Blue Shield of RI Broker Advisory Board, United HealthCare of New England Broker Advisory Board and Rhode Island Business Healthcare Advisors Council. He is also a member of the National Association of Health Underwriters (NAHU), American Health Insurance Association (AHIA) and the Employers Council on Flexible Compensation (ECFC), as well as various human resource associations. Rob is a graduate of Bryant University with a BS in Finance.
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