CMS Establishes System Of Records For Health Insurance Exchanges

The Centers for Medicare and Medicaid Services (CMS) has established a Health Insurance Exchanges (HIX) Program records system to support the Health Insurance Exchanges Program put into place under the Patient Protection and Affordable Care Act (ACA). CMS has set forth details of the records system as required by the federal Privacy Act of 1974. The notice was published in the February 6 Federal Register.

ACA requirements. The ACA requires the CMS to work with state agencies to set up a system of individual and small group exchanges, or health insurance supermarkets, by Oct. 1, 2013. Using this new records system, consumers will have a single application process to determine eligibility for health coverage subsidies, tax credits, premium payments, and cost-sharing responsibilities. The insurance affordability programs that HIX will determine eligibility for include: (1) the advance payment of the premium tax credits (APTC); (2) cost-sharing reductions (CSR); (3) Medicaid; (4) Children’s Health Insurance Program (CHIP); and (5) Basic Health Plan (BHP), if a BHP is operating in the service area of the Health Insurance Exchange.

Personally identifiable information (PII). The system of records will contain PII about certain individuals who apply or who are applying on someone’s behalf and will include personal, employment, financial, demographic, pregnancy status, and tobacco use. The system also will contain information about qualified employers who are seeking to obtain health insurance coverage for qualified employees through a Small Business Health Options Program (SHOP). The CMS will utilize PII for functions such as determining eligibility, enrollment, appeals, payment processes, and consumer assistance.

Data Services Hub. Applicants will have the ability to file their application online, by telephone, in person or by mail with the entity that is administering the eligibility and enrollment functions of the Health Insurance Exchange. An HIX “Data Services Hub” will be used to help insurance exchanges obtain and transmit eligibility information and check applications in real time by pulling data from various government entities such as the Social Security Administration and the Internal Revenue Service. HIX will become effective in 30 days of the notice and written comments should be submitted by that time.

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