DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-9970-NC] Request for Information Regarding the Reinsurance Program under the Affordable Care Act AGENCY: Centers for Medicare & Me dicaid Services (CMS), HHS. ACTION: Request for Information. SUMMARY: This notice is a request for informati on (RFI) to gain market information on entities that could administer a transitional rein surance program. This RFI will inform one or more future Requests for Proposals (RFP). This RFI solicits information about entities that could function as a reinsurance entity for the transitional reinsurance program. CMS or one or more States may contract for services required to fulfill the statutory and regulatory requirements of the reinsurance entity. DATES : Submit written or electronic comments by [ Insert date 30 days after date of publication in the Federal Register]. ADDRESSES: In responding, please refer to file c ode CMS-9970-NC. Because of staff and resource limitations, we ca nnot accept comments by facsimile (FAX) transmission. You may submit responses in one of four ways (please choose only one of the ways listed): 1. Electronically . You may submit electronic comments on this regulation to http://www.regulations.gov . Follow the instructions under the "More Search Options" tab. 2. By regular mail . You may mail written comments to the following address ONLY: Centers for Medicare & Medicaid Services,CMS-9970-NC 2 Department of Health and Human Services, Attention: CMS-9970-NC, P.O. Box 8016, Baltimore, MD 21244-8016. Please allow sufficient time for mailed comments to be received before the close of the comment period. 3. By express or overnight mail . You may send written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-9970-NC, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850. 4. By hand or courier . If you prefer, you may deliver ( by hand or courier) your written comments before the close of the comment peri od to either of the following addresses: a. For delivery in Washington, DC-- Centers for Medicare & Medicaid Services, Department of Health and Human Services, Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue, S.W., Washington, DC 20201.CMS-9970-NC 3 (Because access to the interior of the Hube rt H. Humphrey Building is not readily available to persons without Federal government identification, commenters are encouraged to leave their comments in the CMS drop slots located in the main lobby of the building. A stampin clock is available for persons wishing to reta in a proof of filing by st amping in and retaining an extra copy of the comments being filed.) b. For delivery in Baltimore, MD-- Centers for Medicare & Medicaid Services, Department of Health and Human Services, 7500 Security Boulevard, Baltimore, MD 21244-1850. If you intend to deliver your comments to the Baltimore address, please call telephone number (410) 786-9994 in advance to schedule your arrival with one of our staff members. Comments mailed to the addresses indicated as appropriate for hand or courier delivery may be delayed and received after the comment period. For information on viewing public comments, see the beginning of the "SUPPLEMENTARY INFORMATION" section. FOR FURTHER INFORMATION CONTACT: Milan Shah, 301-492-4427. SUPPLEMENTARY INFORMATION : Inspection of Public Comments: All comments received before the close of the comment period are available for viewing by the public, includi ng any personally identif iable or confidential business information that is included in a comment. We post all comments received before the close of the comment period on the following Web si te as soon as possible after they have beenCMS-9970-NC 4

received: http://www.regulations.gov . Follow the search instructions on that Web site to view public comments. Comments received timely will also be avai lable for public inspection as they are received, generally beginning approximately 3 w eeks after publication of a document, at the headquarters of the Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244, Monday through Friday of each week from 8:30 a.m. to 4 p.m. To schedule an appointment to view public comments, phone 1-800-743-3951. We note that responses to this RFI are not offers, and cannot be accepted by the Government to form a binding contract or to issue a grant. The purpose of this RFI is to inform one or more Requests for Proposals, not to ga ther public comments on the proposed rules for reinsurance, risk corridors, or risk adjustment under the Affordable Care Act. Those comments have been collected and are being evaluated separately. Informati on obtained in response to this RFI may be used by the Government for program planning and development, or other purposes with or without attribution. Do not include any information that might be considered proprietary or confidential. I. Background Section 1341 of the Patient Protection and Affordable Ca re Act (Pub. L. 111-148, enacted on March 23, 2010) (the Affordable Care Act) , provides that each State must establish a transitional reinsurance program to help stabilize premiums for coverage in the individual market during the first three years of Exchange operati on (2014-2016). The rein surance program, which is a State-based program, will reduce the uncertainty of insurance risk in the individual market by making payments for high-cost cases. This program will stabilize individual market rate increases that might otherwise occur because of the immediate enrollment of individuals withCMS-9970-NC 5 unknown health status, potentially including, at the State’s discre tion, those currently in State high-risk pools. CMS published proposed rules fo r States and health insurance issuers for this reinsurance program on July 15, 2011 (76 FR 41930). The Affordable Care Act instructs each State to establish or contract with an entity to carry out the reinsurance program . Section 1321(c)(1) of the Affo rdable Care Act directs the Secretary to take such actions as are necessary to implement the reinsurance program in a State if a State has not taken action necessary to do so. The reinsurance entit y, whether operating under contract with a State or CMS, must be a not-for-profit organiza tion with a tax-exempt status. II. Request for Information This RFI seeks comment on the entities that could carry out the tr ansitional reinsurance program. CMS may enter into one or more cont racts to fulfill the statutory and regulatory requirements of the transitional reinsurance program established under section 1341 of the Affordable Care Act depending on the workload and number of States that would require assistance. In such a case, the contractor ma y be tasked with one or more of the following functions:

• Collecting reinsura nce contributions;

• Accepting and validating request s for reinsurance payments;

• Remitting reinsurance payments;

• Reconciling and verifying reinsura nce contributions and payments;

• Maintaining records; and,

• Providing customer support to issuers. CMS is seeking to engage formally, in a transparent and participatory manner, with entities that understand the reinsura nce market, and would be able to perform the responsibilitiesCMS-9970-NC 6 of a reinsurance entity under the statute and associated regulations. In carrying out the transitional reinsurance program, CMS seeks to m itigate conflicts of interest (COI) that may arise if potential market competitors operate the reinsurance program. As such, we request any information on potential COIs, and potential av enues for mitigation, from all stakeholders, including issuers and third- party administrators. Infrastructure 1. Does your organization operate as a not-for-p rofit reinsurance enti ty in the State(s) in which you currently conduct business? 2. If your organization operates as a reinsu rance entity but doe s not function as a not-for-profit, what steps would have to be taken to convert the organization or the part of that organization responsible for reinsurance operatio ns into a not-for-profit entity? What other considerations should be take n into account in connection with such a conversion? 3. What other steps must your organization take in order to be prepared to smoothly transition into a role as administrator of a new temporary reinsurance program? 4. Does your organization operate nationally or in limited geographic areas? If the latter, what are the geographic areas? 5. Would your organization be able and willing to contract with a State and/or the Federal government to operate a temporary reinsurance program? 6. Are there any State and/or local licensing re quirements that must be considered by an organization operating as such a reinsurance entity? 7. What potential conflicts of interest (COI) could arise if your or ganization were to operate such a reinsurance progr am as a not-for-profit entity ? How might these COIs be mitigated?CMS-9970-NC 7

8. For organizations that do not currently have COI mitigation programs, what steps would have to be taken to develop and execute such a program? 9. What is a reasonable amount of time fo r your organization to become fully operational (for example, have all systems in pl ace to operate a reinsura nce program) after the date of a contract award? Wh at resources woul d be necessary? Collection and Disbursement of Reinsurance Funds 10. Describe your organization’s ability to perform the following functions:

• Collecting reinsura nce contributions;

• Accepting and validating request s for reinsurance payments;

• Remitting reinsurance payments; and,

• Reconciling and verifying reinsuranc e contributions and payments. 11. What services related to the collection of reinsurance contributions, or disbursement of reinsurance payments to another entity would your organization need to subcontract due to a lack of capacity, expertise, or experience? 12. What COIs could arise for su ch potential subcontractors? Data Collection 13. Describe current data systems that ar e used by your organization, including any standards, security systems, and web-based interac tive structure. Are yo ur systems compliant or have the capability of bei ng Section 508 compliant < http://www.section508.gov/ >? 14. Do your organization’s current data systems have the capability to interface with external systems to accept data and reports? If ye s, what types of interf aces are currently in place? 15. What data are currently collected by your organization related to medical costs?CMS-9970-NC 8

16. What is your organization’s current capac ity for collecting and verifying claims submissions from issuers? What processes does your organization have in place to ensure confidentiality and security protec tions of patient information? 17. In what formats does your organizati on currently collect data? Can your organization support other form ats? If so, which ones? 18. Would your organization need to subcontract an y services related to data collection? 19. What COIs could arise for such subcontractors? Customer Support 20. What telecommunication and technical support systems does your organization currently maintain for health insurance issuers or other commercial clients (for example, websites, 24-hour hotlines, helpdesk)? 21. Are your support systems compliant or have the capability of being Section 508 compliant < http://www.section508.gov/ >? 22. Would your organization need to subcontract an y services related to data collection? 23. What COIs could arise for such subcontractors? Evaluation 24. Does your organization curren tly conduct evaluations of ope rations and activities? Do such evaluations include a financial as sessment of your organi zation’s activities? 25. What are your organization’s current financ ial and data reconciliation processes?Authority: (Catalog of Federal Domestic Assistan ce Program No. 93.773, Medicare--Hospital Insurance; and Program No. 93.774, Medicare--S upplementary Medical Insurance Program)

Dated: January 20, 2012

_______________________________ Charles Littleton Contracting Officer, Office of Acquisition and Grants Management, Centers for Medicare and Medicaid Services.

BILLING CODE 4120-01-P

[FR Doc. 2012-1944 Filed 01/27/2012 at 8: 45 am; Publication Date: 01/30/2012]