CMS to develop eligibility tools for insurance exchanges

CMS wants to use best data to determine eligibility for insurance coverage.

WASHINGTON – The Centers for Medicare and Medicaid Services plans to develop verification data and services to support coverage and eligibility infrastructure for health insurance exchanges and seeks industry information about applications that are available.

A solution that verifies eligibility for qualifying coverage in an employer-sponsored plan is part of the process for determining whether an individual qualifies for advance payment of the premium tax credit that is available to support the purchase of health plans through the exchanges.

CMS wants to identify authoritative data sources that can be used or adapted to meet the verification requirement and also how to develop new data sources that could fulfill that condition, according to a request for information in Federal Business Opportunities. Responses were due last month.

Among solutions that the Health and Human Services Department has proposed in a rule describing health insurance exchanges is development of a database that contains authoritative data to assure employer-sponsored coverage.

The Patient Protection and Affordable Care Act did not require this data, so population of a potential database would be voluntary. And no data sources currently exist that contain comprehensive information about access to employer-sponsored coverage or the affordability and minimum value of such coverage, according to the notice.