The Centers for Medicare & Medicaid Services hope to begin taking a look at commercial exchange plan compliance in 2015.
Specifically, Center for Consumer Information & Insurance officials talk about the upcoming “qualified health plan” compliance reviews in the final version of a letter the agency is sending to the carriers that might sell plans through the exchanges in 2015.
The new “2015 issuer letter” applies directly only to the federal-run exchanges.
Officials have said they will look at plan provider network descriptions more carefully and tighten some other standards.
In the section on plan issuer compliance reviews, officials say CMS will use complaint data, issuers own reports, and other data to look for possible problems.
CMS will perform a “limited number of compliance reviews” in 2015, CCIIO officials say.
CMS may look both at the plans sold through an exchange and the carriers that sells the plans, officials say.
“CMS intends to coordinate with the state regulatory entities, where appropriate, in conducting the compliance reviews,” officials say.