Implementing Health Reform: The Qualified Health Plan Federal Exchange Participation Agreement And More
October 21st, 2014
CMS continues to put the pieces into place that are needed for the launch of the 2015 coverage year. On October 16, 2014, the Centers for Medicare and Medicaid Services released at its REGTAP.info website the certification agreement and privacy and security agreement that qualified health plan (QHP) insurers must sign with CMS to access the federally facilitated exchange (FFE), the federally facilitated SHOP (FF-SHOP), and CMS Data Services Hub. The agreement focuses primarily on obligations that the QHP insurer undertakes to protect personally identifiable information and to ensure secure communications with CMS, although it also addresses the effective date and termination of the agreement and a few other issues. Most of the terms of the agreement are unremarkable, and this post will only comment on a few.
QHP insurers undertake under the agreement to protect personally identifiable information and to ensure secure communications with CMS in conformity with applicable laws, regulations, and standards. They must also ensure that their contractors and downstream entities comply with these requirements. QHP insurers agree to report any personally identifiable information incidents or breaches to CMS within 72 to 96 hours. This is a far cry from the one-hour breach reporting requirement proposed by CMS last year but never finalized, but perhaps recognizes the difficult of identifying and assessing a security breach.
The agreement expressly recognizes that QHP insurers have developed their products based on the assumption that advance premium tax credits and cost-sharing reduction payments will be available through the marketplace and that QHP insurers could have cause to terminate the agreement if this assumption ceases to be valid. This could be interpreted as a reference to the Halbig/King litigation which currently threatens the availability of tax credits and cost-sharing reduction payments through the FFE, but could also have been included in recognition of the likely Republican takeover of the Senate and the possibility that the Republicans may accomplish through budget reconciliation or otherwise their longstanding goal of repealing the ACA. As the agreement is renewable from year to year, this clause may contemplate contingencies in the indefinite as well as the near futureRead the rest of this entry »