```

[Federal Register Volume 77, Number 19 (Monday, January 30, 2012)]
[Notices]
[Pages 4564-4566]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-1944]

-----------------------------------------------------------------------

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 & Medicaid Services (CMS), HHS.

ACTION: Request for information.

-----------------------------------------------------------------------

SUMMARY: This notice is a request for information (RFI) to gain market 
information on entities that could administer a transitional 
reinsurance 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 February 29, 2012.

ADDRESSES: In responding, please refer to file code CMS-9970-NC. 
Because of staff and resource limitations, we cannot 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

[[Page 4565]]

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, 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 period 
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 SW., Washington, DC 
20201.

    (Because access to the interior of the Hubert 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 stamp-
in clock is available for persons wishing to retain a proof of filing 
by stamping 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, 
including any personally identifiable 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 
site as soon as possible after they have been received: http://www.regulations.gov. Follow the search instructions on that Web site to 
view public comments.
    Comments received timely will also be available for public 
inspection as they are received, generally beginning approximately 3 
weeks 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 gather 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. Information 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 Care 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 operation (2014-2016). 
The reinsurance 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 with unknown health status, 
potentially including, at the State's discretion, those currently in 
State high-risk pools. CMS published proposed rules for 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 Affordable 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 entity, whether operating under contract with a State or 
CMS, must be a not-for-profit organization with a tax-exempt status.

II. Request for Information

    This RFI seeks comment on the entities that could carry out the 
transitional reinsurance program. CMS may enter into one or more 
contracts 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 may be tasked 
with one or more of the following functions:
     Collecting reinsurance contributions;
     Accepting and validating requests for reinsurance 
payments;
     Remitting reinsurance payments;
     Reconciling and verifying reinsurance 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 reinsurance 
market, and would be able to perform the responsibilities of a 
reinsurance entity under the statute and associated regulations. In 
carrying out the transitional reinsurance program, CMS seeks to 
mitigate conflicts of interest (COIs) that may arise if potential 
market competitors operate the reinsurance program. As such, we request 
any information on potential COIs, and potential avenues for 
mitigation, from all stakeholders, including issuers and third-party 
administrators.

Infrastructure

    1. Does your organization operate as a not-for-profit reinsurance 
entity in the State(s) in which you currently conduct business?
    2. If your organization operates as a reinsurance entity but does 
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 operations into a not-for-profit entity?

[[Page 4566]]

What other considerations should be taken 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 requirements that 
must be considered by an organization operating as such a reinsurance 
entity?
    7. What potential conflicts of interest (COIs) could arise if your 
organization were to operate such a reinsurance program as a not-for-
profit entity? How might these COIs be mitigated?
    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 for your organization to 
become fully operational (for example, have all systems in place to 
operate a reinsurance program) after the date of a contract award? What 
resources would be necessary?

Collection and Disbursement of Reinsurance Funds

    10. Describe your organization's ability to perform the following 
functions:
     Collecting reinsurance contributions;
     Accepting and validating requests for reinsurance 
payments;
     Remitting reinsurance payments; and,
     Reconciling and verifying reinsurance 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 such potential subcontractors?

Data Collection

    13. Describe current data systems that are used by your 
organization, including any standards, security systems, and web-based 
interactive structure. Are your systems compliant or have the 
capability of being 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 yes, 
what types of interfaces are currently in place?
    15. What data are currently collected by your organization related 
to medical costs?
    16. What is your organization's current capacity for collecting and 
verifying claims submissions from issuers? What processes does your 
organization have in place to ensure confidentiality and security 
protections of patient information?
    17. In what formats does your organization currently collect data? 
Can your organization support other formats? If so, which ones?
    18. Would your organization need to subcontract any 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, Web sites, 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 any services 
related to data collection?
    23. What COIs could arise for such subcontractors?

Evaluation

    24. Does your organization currently conduct evaluations of 
operations and activities? Do such evaluations include a financial 
assessment of your organization's activities?
    25. What are your organization's current financial and data 
reconciliation processes?

    Authority:  Catalog of Federal Domestic Assistance Program No. 
93.773, Medicare--Hospital Insurance; and Program No. 93.774, 
Medicare--Supplementary Medical Insurance Program.

    Dated: January 20, 2012.
Charles Littleton,
Contracting Officer, Office of Acquisition and Grants Management, 
Centers for Medicare and Medicaid Services.
[FR Doc. 2012-1944 Filed 1-27-12; 8:45 am]
BILLING CODE 4120-01-P
```