Linda Tiano Quoted in Article “Federal Insurance Marketplaces May Have To Perform Some Functions Manually”

Bloomberg BNA's Health Care Daily Report

Linda Tiano, a Member of the Firm in the Health Care and Life Sciences practice, in the Washington, DC, and New York offices, was quoted in an article titled "Federal Insurance Marketplaces May Have to Perform Some Functions Manually."

Following is an excerpt:

The online health insurance marketplaces that will be run by the federal government in 33 states will start selling health plans Oct. 1, but some of the functions that need to be performed to determine eligibility for Medicaid and tax credit subsidies may have to be done manually, an attorney said May 8 in a webinar.

"In terms of all the interfaces, with Medicaid, with the [Internal Revenue Service], being able to transmit everything electronically, those are complicated things," Linda Tiano said. "They will be running. They'll have qualified health plans that are offered, but my guess is, initially at least, a lot of it is going to have to be manual." ?...

The deadline for health plans to file qualified health plan (QHP) applications for the federally facilitated marketplaces (FFMs) was extended for three days until May 3, "primarily due to the fact that there were many [information technology] issues and the system kept crashing, and people were having trouble loading their data," Tiano said.

The Centers for Medicare & Medicaid Services and the Center for Consumer Information and Insurance Oversight (CCIIO), the CMS office that is implementing the marketplaces and other ACA health insurance market reforms, are taking on major new regulatory responsibilities over the industry, Tiano said. "CMS and CCIIO will be a new regulator in the insurance market," she said. ?...

CMS expects to release the results of its initial review of QHP applications June 17. Plans will have until June 21 to correct any deficiencies found. CMS also will be seeking state opinions on QHP rates and network adequacy, and issuers will be able to review data and submit corrections from Aug. 22-Aug. 26, Tiano said. Plans are to be notified by Sept. 4 of final decisions, and agreements must be signed between Sept. 5 and Sept. 9, she said. Because of the very tight time frames, she said, it is unlikely there will be much negotiation over the agreements at that point.