News

The Government Relations and Exchange Policy Workgroups are developing comments in response to a CMS paperwork reduction act notice
that outlines some technical specifications around an Exchange
requirement for carriers to submit machine readable data for provider
networks. This requirement was finalized as part of the Final Benefit and Payment Parameters.
Presumably, the files could be used to create search functions within
healthcare.gov itself; however, these files will also be shared with
third-parties to “create innovative and informative tools to help
enrollees better understand the plan’s provider network.”

NADP members
have expressed concern regarding the transfer of this data to
third-parties. There is very little information at this time on who the
third-parties may be, what the agreement between those parties and CMS
will entail, and thus the ability for third-parties to display,
manipulate, distribute or sell the data. Also, NADP will look to clarify
that carriers seeking exchange certification for offer solely off the
Marketplaces will be exempt from the monthly submission process. In
addition to these concerns, volunteers are also exploring whether
comments on the technical specification are warranted.

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