CMS: Reinsurance-eligible health plans to receive early 2015 payment

The Centers for Medicare & Medicaid Services expects in March to make an early partial payment to eligible health plans under the transitional reinsurance program for the 2015 benefit year, in part due to surplus 2014 funds. “Reinsurance funds not paid out through this early payment will be paid out in late 2016, as part of the standard reinsurance data submission, validation, calculation and payment process,” the agency said. CMS will calculate the early payment based on accepted enrollment and claims data as of Feb. 1, 2016, and encourages all issuers to load all available claims and enrollment data for the 2015 benefit year by 5 p.m. on that date. Data loaded for the early reinsurance payment will be subject to CMS data validation checks prior to calculation of reinsurance payment amounts. Reinsurance payments are based on a portion of an issuer’s costs (coinsurance rate) paid per enrollee above a certain level and until a payment limit. CMS will make the early payment at a coinsurance rate of 25%, and expects to announce the final 2015 coinsurance rate in June 2016 based on total available reinsurance collections and accepted payment requests.