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From Health Law Daily, April 3, 2013

CMS should increase oversight of insurers’ submissions to website for small group, individual plans

By Michelle L. Oxman, JD, LLM

The data on the federal web site designed to help individuals and small groups find health coverage contains omissions and inaccuracies (OIG Report, No. OEI-03-11-00560, April 1, 2013). In a review of CMS’ oversight of the insurers’ submissions for posting to the Plan Finder web site, the Office of Inspector General (OIG) found that CMS: (1) could not identify all insurers required to submit information for the site; (2) did not follow up with insurers who failed to report the data as required; (3) did not require insurers to certify that the records were both accurate and complete. In addition, the data on the site did not match the data available to the insurers’ representatives who responded to customer inquiries.

The plan finder. The Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148) requires HHS to develop and maintain a web site that will help people looking for coverage in the small group and individual markets find a plan that meets their needs. To the extent that the information is inaccurate or incomplete, the site will confuse consumers and make the enrollment process more difficult. CMS created the Plan Finder web site to satisfy this requirement.

Insurers’ failure to report. CMS expected 1,026 insurers to report plan and benefit information for the November 2011 and February 2012 reporting periods. About 13 percent of the insurers, 129, failed to report at all. The agency had no mandatory, standard process to identify the insurers that were required to report. Another 41 reported data that did not meet the technical requirements and was excluded from the plan finder.

Inaccurate or inconsistent information. The OIG found that the plans and products listed on the Plan Finder website were not always actually available for sale or were not recognized by the insurers’ representatives. When the OIG reviewed the plans that were both recognized by the insurers and available for sale, it found that about 81 percent of the data reported matched the information available to insurance company representatives, meaning that 19 percent of entries were inconsistent, inaccurate, or incomplete. Errors included statements that a plan did not cover prescription drugs where the plan also linked to a formulary; benefit levels with extremely low numbers, such as a $4,000 annual limit for all services; failure to indicate that certain benefits were subject to limitations or exceptions, where the insurer had submitted the information; and cost sharing numbers with aberrant values.

OIG’s recommendations. The OIG recommended that CMS: (1) establish and implement procedures to identify insurers required to report and to follow up with those who fail to do so; (2) require either the chief executive officer or the chief financial officer to certify that the data submitted are both accurate and complete; (3) add to its existing quality checks in order to correct the errors and inconsistencies described; and (4) confirm that the plans and products submitted actually are available for sale. Additional guidance or more specific standards for data entry may help to resolve the problems.

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