State Based Exchange (SBE) Enrollment Reporting Office Hours Center for Consumer Information and Insurance Oversight (CCIIO) March 4, 2020 This communication was printed, published, or produced and disseminated at U.S. taxpayer expense. The information provided in this presentation is only intended to be a general informal summary of technical legal standards. It is not intended to take the place of the regulations that it is based on. We encourage audience members to refer to the applicable regulations for complete and current information about the requirements that apply to them.
Agenda • General Updates • Restatement Timeline • State-Based Marketplace Response (SBMR) File Schema Update • Disputes Update • Production Payment Cycle Calendar • Reference Documents • Q&A INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and 2 confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
General Updates INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
General Updates • CMS will schedule both the SBE and issuer meetings on a quarterly basis instead of monthly. • Please send SBE contact updates via email to FMCC fmcc@cms.hhs.gov. • If you have any ingestion or data issues, please email the FEPS Help Desk at CMS_FEPS@cms.hhs.gov as soon as possible. INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and 4 confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
Restatement Timeline INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
Restatement Timeline Calendar Year 2020 2021 2022 Coverage Year 2020 2019 2018 2021 2020 2019 2018 2022 2021 2020 2019 2018 Jan Feb Mar Submission Month Apr May Jun Jul Aug Sep Oct Nov Dec +2021 +2022 +2023 Submission Schedule : Current Plan Year (submit monthly) Current Plan Year -1 (submit monthly through June, and then quarterly beginning September) Current Plan Year -2 (submit quarterly) Current Plan Year -3 (submit yearly) Current Plan Year -4 (submit yearly) Note: This timeline is subject to change as CMS will continue to perform analysis and consult with the SBEs to determine if adjustments are needed. INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and 6 confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
Restatement Timeline, continued – For 2018 plan year files: • Quarterly submissions will continue through the end of 2020. • Yearly submissions will begin June 2021 and continue for up to five additional years. • CMS is willing to be flexible as to the timing of submissions and will work with the SBE to work through special circumstances. INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and 7 confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
Restatement Timeline, continued – For 2019 plan year files: • Monthly submissions will continue through the June submission (July payment cycle). • Quarterly submissions will begin September 2020 and continue through the end of 2021. • Yearly submissions will continue after the quarterly submission period ends for up to five additional years. INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and 8 confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
Restatement Timeline, continued • The State-Based Marketplace Inbound (SBMI) submission window is the 1 st through the 10 th of each month. • The freeze period each month is the 11 th through the 15 th . CMS requires SBE files prior to the 11 th . The SBE may send files during the freeze period, but this timeframe should only be used in extenuating circumstances. • Because restated changes for prior years are not as numerous, SBEs may send a prior-year file before the 1 st of each month. For example, a 2018 file may be sent between the 16 th and the last day of the month. – If the SBE plans to send any file outside of the 1 st through 10 th please send email to CMS at sbmenrollment@cms.hhs.gov INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and 9 confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
SBMR Schema Update INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
SBMR Schema Changes for SBEs • To better represent the multiple file level errors and warnings reported on the SBMR, a minor schema change is required which will remove the current File Error node limitation of allowing only one error or warning per SBMI File Info node. • SBEs consuming the SBMR for processing will need to update the SBMR XML Schema Definition (XSD): Old Schema: New Schema: INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and 11 confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
Go-Live Date • 6/26/2020 Go-Live date – Update SBMR schema to allow for multiple FileError nodes within a single SBMIFileInfo node – No files processed in July should be delayed INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and 12 confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
Disputes Updates INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
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