HIOS MLR Training

Filing Medical Loss

Ratio and Risk

Corridors Annual

Reports through HIOS

HIOS MLR TRAINING SESSION

 Welcome

 Overview

 System Walkthrough

 Next Steps and Wrap up

 Q&A

Agenda

 Objective

 Provide general information on the MLR and Risk

Corridors reporting process.

 Provide specific steps for filing your MLR and Risk

Corridors reports.

 Approximately 45 minute session with Q&A at

the end.

 Please hold your questions until the end.

Welcome

 The Affordable Care Act requires health insurance

issuers to publicly report data on major categories of

spending of policyholder premium, including the portion

of premium revenues spent on clinical services provided

to enrollees, quality improvement activities, and on all

other non-claims costs. The amount of premium spent

on clinical services and quality is known as the Medical

Loss Ratio (MLR).

 The Center for Consumer Information and Insurance

Oversight (CCIIO) Medical Loss Ratio (MLR) division

has been charged with collecting the MLR data.

Overview – MLR Program

 The Health Information Oversight System (HIOS) Medical

Loss Ratio Reporting System (MLR module) has been

identified as the system of record to support the collection

of the MLR data.

 The MLR data will be collected using Excel templates

(MLR-A and Risk Corridors Plan-Level Data templates).

 The submission window for the 2014 reporting year will

open on July 1, 2015.

 Submissions for the 2014 reporting year are due by July

31, 2015.

Overview- MLR Program

 The temporary risk corridors program is intended to

protect individual and small group market Qualified Health

Plans (QHPs) against rate-setting uncertainty and provide

greater premium stability for these plans during the 2014-

2016 benefit years.

 The risk corridors program applies only to QHP issuers

(excluding stand-alone dental plans).

 Issuers will submit risk corridors data through the HIOS

MLR module during the same submission window as MLR

(July 1-July 31, 2015).

Overview – Risk Corridors

Program

 Risk corridors data will be collected in two ways:

 Parts 1-3 of the MLR Form

 Risk Corridors Plan-Lev

el Data Form

 This includes data on premium earned, profit, allowable

costs, taxes, and allowable administrative expenses.

 Data is used to calculate the risk corridors payment or

charge amount, which is incorporated into the calculation

of the issuer’s MLR.

 Note: CMS will hold separate trainings on June 1st &

3rd to provide detailed instructions on completing the

Risk Corridors Plan-Level Data Form.

Overview – Risk Corridors

Program

Overview – Risk Corridors

Program

The MLR reporting process involves the following

steps:

Step 1 – Register for the HIOS MLR module.

Step 2 – Confirm company-issuer associations.

Step 3 – Download MLR-A templates.

Step 4 – Populate MLR-A templates.

Step 5 – Upload completed MLR-A templates.

Step 6 – Download Risk Corridors Plan Level Data templates.

Step 7 – Populate Risk Corridors Plan Level Data templates.

Step 8 – Upload completed Risk Corridors Plan Level Data

templates.

Step 9 – Upload supplemental materials.

Step 10 – Attest to accuracy of uploaded MLR data, Risk

Corridors Plan Level data, and supplemental materials.

The MLR Reporting

Process

 HIOS is accessed through the CMS Enterprise Portal at

https://portal.cms.gov/

 All existing HIOS users can log in with their EIDM credentials.

 New HI

OS users need to register in EIDM and obtain an EIDM

User ID and Password.

 In o

rder to gain access to the HIOS MLR module, all users must:

 Login to the CMS Portal using their EIDM User ID and P

assword.

 Access HIOS.

 Request access t

o the HIOS MLR module and their associated

user role.

 Note: Us

ers must request their individual user roles for each company.

Existing users will retain their existing HIOS user roles and are not

required to submit another user role request.

Accessing HIOS through

CMS Enterprise Portal

Users will log into the Enterprise Portal with their EIDM Credentials.

EIDM Login for Existing HIOS Users

 New HIOS users will need to complete the

following steps to access HIOS:

 Register for an EIDM account.

 Register in HIOS.

 Request ac

cess to HIOS in the CMS Enterprise

Portal.

 Register organi

zation if it is not currently

registered in HIOS (optional).

 Request ac

cess to required roles in HIOS

(optional) (example – MLR Uploader, MLR CEO

Attester).

New Users

New users will navigate to the Enterprise Portal to start the registration process.

EIDM Account Registration for

New Users

EIDM Account Registration for

New Users

 Complete the remaining

steps to create your CMS

- HIOS User account.

 Once the u

sers fill in the

required information and

select ‘Submit’ button,

the request will be sent

for approval.

 The users will receive an

ail notification when

the user account has

been approved. The

email will explain the

additional steps required.

Accessing HIOS in the

Enterprise Portal

Users that have registered in EIDM, registered in HIOS, and acquired access to

HIOS in the portal will be directed to the My Portal landing page. Clicking the

‘HIOS’ tab will open the HIOS landing page.

Self Registration for New HIOS

Users

Select the “Register for New Account” link located in the middle of the HIOS

Sign-In page.

Self Registration for New HIOS

Users

 Complete the Self

Registration page.

 Once the u

sers fill in

the required

information and select

‘Submit’, the request

will be sent for

approval.

 The users will receive

an em

ail notification

when the user account

has been approved.

Access HIOS Home Page

Registering a New

Company In HIOS

HIOS Main Page – Manage an

Organization

Click on ‘Manage an

Organization’ tab on

the HIOS homepage.

Registration Process

Step 1: Register the Organization in HIOS

 To determine if the company is already registered in HIOS,

search by the company’s Federal Employer Identification

Number (EIN).

 If the company does not already exist in HIOS, users will

need to

 All registration requests are reviewed prior to approval.

 If the company already exists in HIOS, users may proceed

rectly to Registration Overview – Step 2.

Search by Federal EIN

 Select “Create New

Organization” as the

purpose of your visit.

 Select “C

ompany” as

type of organization.

 Type the Federal EIN

of your company in the

textbox and click the

‘Search’ button.

Company Search Results

 If your company’s

Federal EIN is not

registered in HIOS, the

following message will

be displayed:

 “No Organization

ound”

 To register a new

ompany, select if your

primary business is

health coverage and

click the

‘Create

Organization’

button.

 Fill in the following

required information

to register a new

company:

 Organization Legal

Name

 Domiciliary A

ddress

 Click the ‘Continue’

button to continue

entering your

company’s information

before submitting the

request to register a

new company.

Organization

 Fill in the following

required information to

 Incorporated State

 While not mandatory,

provide your organization’s

NAIC Company and Group

Codes and Group Name, if

applicable.

 Click the

‘Review/Continue’

button to review your

company’s information

before submitting the

request to register a new

company.

New HIOS Company Creation –

Review

 Review your company’s

information and click the

‘Submit’ button to submit

your request for

approval.

 If changes are required,

click t

‘Back’ button to

make any changes.

 The users wi

ll receive an

email notification

confirming the approval

of the submitted request.

User Role Management

Step 2: Determine MLR user role and request access to

the company.

 Users will need to determine their user role and identify the

company to which they need access.

 If users need to update

their current MLR user role to another

user role, they will need to contact the Exchange Operations

Support Center (XOSC) at [email protected]

remove their current user role.

 If another user is already associated to the user role you are

requesting, you will need to contact the XOSC to remove

association from the other user.

 Once t

he user role has been removed from the other user, you

can proceed with requesting that user role for yourself.

Registration Process

(cont’d)

 Below is a brief description of the various user roles within the

MLR module:

 Primary/Backup Uploader – This user is responsible for uploading the

MLR-A and Risk Corridors Plan Level Data Templates through the HIOS

MLR module.

 Primary/Backup CEO Attester – This user is responsible for attesting to

the accuracy and completeness of the MLR and Risk Corridors Plan Level

data and supplemental materials submitted.

 Primary/Backup CFO Attester – T

his user is responsible for attesting to

the accuracy and completeness of the MLR and Risk Corridors Plan Level

data and supplemental materials submitted.

 Users can only have access to one user role at a time for each

company.

 Each c

ompany must ensure an Uploader, CEO Attester, CFO

Attester, and their back-ups have access to HIOS.

MLR User Roles

HIOS Main Page – Role

Management

Click the ‘Role

Management’

tab on the

HIOS Homepage.

Select Role

 Select the module as “Medical

Loss Ratio Data Collection

System (MLR)” from the

dropdown.

 Select Requested Role as

“Company”.

 You may select one of the following

user roles from the User Type

dropdown:

 Uploader

 CEO Attester

 CFO Attester

 You may select the User Sub-Type

“Primary” or “Back-up”.

 After the selections have been

completed, click the

‘Continue’

button.

Company Association

 Enter the FEIN of the

company to which you wish to

request access in the textbox

and click the ‘Search’ button.

 Once your company has been

found,

click the

‘Review/Continue’ button to

review your new role request.

 Note: P

lease ensure that you

are not already associated to

a user role for this company,

or another user is not already

associated to the user role

you are requesting.

Request Role – Review

 Review your selections and

click the ‘Submit’ button to

submit the new role

request for approval.

 If changes are required,

click

the ‘Back’ button to

make any changes.

 The users will receive an

email notification once the

role request has been

submitted for approval and

approved.

Registering a New Issuer

in HIOS

HIOS Main Page – Manage an

Organization

 If the Issuer is not

already registered in

HIOS, users will first

need to register the

Issuer in HIOS. To

HIOS:

 Click the ‘Manage an

Organization’ tab on

the HIOS Homepage.

Search for Existing Company

 After selecting the

purpose of your visit

and type of

organization, search for

your company by using

the company’s FEIN.

 Any i

ssuers already

associated to your

company will be

displayed under the

Issuers section.

 To add new

issuers,

click the

‘Add Issuer’

button.

 Fill in the required issuer

information:

 Registered State

 Market Type and Line of

usiness

 Domiciliary A

ddress

 Click the ‘Save and Add

Another Issuer’ button

to submit and/or add more

than one issuer.

Submit Issuer Request

 Once the new issuer(s) are

ready for submission, click

the

‘Submit’ button.

 After the request to register

the

issuer(s) has been

submitted, the users will

receive an email notification

with the new HIOS Issuer ID.

Please save this email for

future reference.

Accessing the MLR Homepage

To access the MLR

module, click the ‘Medical

Loss Ratio Data

Collection System

(MLR)’ tab on the HIOS

homepage.

MLR Homepage

The MLR reporting process involves the following steps:

Step 1 – Register for the HIOS MLR module.

Step 2 – Confirm company-issuer associations.

Step 3 – Download MLR-A templates.

Step 4 – Populate MLR-A templates.

Step 5 – Upload completed MLR-A templates.

Step 6 – Download Risk Corridors Plan Level Data

templates.

Step 7 – Populate Risk Corridors Plan Level Data templates.

Step 8 – Upload completed Risk Corridors Plan Level Data

templates.

Step 9 – Upload supplemental materials.

Step 10 – Attest to accuracy of uploaded MLR data, Risk

Corridors Plan Level data, and supplemental materials.

The MLR Reporting Process

 Every company will need to confirm the list of its associated

issuers for which the company will report MLR data for the

reporting year (e.g., for which States it will be reporting).

 HIOS will utilize the list of confirmed issuers to

generate an

MLR-A template for each issuer, with the Company Information

tab pre-populated with the company and issuer information

(e.g., HIOS ID, FEIN, Company Name, etc.).

 The list of confirmed issuers w

ill also be utilized to verify that

we receive completed MLR-A templates for all issuers expected

to be included in the report.

 You will not be able to download the pre-popul

ated MLR-A

templates and Risk Corridors Plan-Level Data templates (if

applicable) until you confirm the associations.

Purpose of Confirming

Company-Issuer Associations

 Select the “Company/Issuer Association” tab.

 Select the “C

ompany”.

 Select the “R

eporting Year”.

 Click ‘V

iew Associations’.

 Confirm the list of issuers by

clicking ‘Confirm’

 Update the pre-populated M

LR Company-

Issuer Association Form to add or remove

any issuers.

 Upload the updated form back to the MLR

modul

 Indicate i

f your company has only a small

closed block of business as described in the

2014 MLR Reporting Form Instructions.

 Indicate your company’s federal tax exempt

tatus, as established by the Internal Revenue

Service.

Confirming Company-Issuer

Associations

MLR Company-Issuer

Association Form Example

The MLR reporting process consists of the following steps:

Step 1 – Register for the HIOS MLR module.

Step 2 – Confirm company-issuer associations.

Step 3 – Download MLR-A templates.

Step 4 – Populate MLR-A templates.

Step 5 – Upload completed MLR-A templates.

Step 6 – Download Risk Corridors Plan Level Data

templates.

Step 7 – Populate Risk Corridors Plan Level Data templates.

Step 8 – Upload completed Risk Corridors Plan Level Data

templates.

Step 9 – Upload supplemental materials

Step 10 – Attest to accuracy of uploaded MLR data, Risk

Corridors Plan Level data, and supplemental materials.

The MLR Reporting Process

 Each company will have access to a set of MLR-A template

files for each issuer with pre-populated company information,

as well as an MLR-A template for the company’s national

Grand Total numbers.

 The MLR module will generate a zip file containing all MLR-A

tem

plate files for the selected company and MLR reporting

year.

 The zip file will only become available for downl

oad after

company-issuer associations have been confirmed.

Overview of Downloading

MLR-A Templates

 Log into the HIOS MLR module.

 Select the “

Download Templates” tab.

 Select the “

Company”.

 Select the “

Reporting Year”.

 Click “Download Files”.

 The MLR module will generate a zip file containing pre-

popul

ated MLR-A Templates (separate Excel files for each

State of operation, plus one Excel file for the Grand Total),

available for download (named “HHS-MLR-2014.zip”).

 Extract the contents of the zip file into a folder on your

omputer.

Downloading the MLR-A

Templates

Downloading the MLR-A

Templates (screenshot)

The MLR reporting process consists of the following steps:

Step 1 – Register for the HIOS MLR module.

Step 2 – Confirm company-issuer associations.

Step 3 – Download MLR-A templates.

Step 4 – Populate MLR-A templates.

Step 5 – Upload completed MLR-A templates.

Step 6 – Download Risk Corridors Plan Level Data

templates.

Step 7 – Populate Risk Corridors Plan Level Data templates.

Step 8 – Upload completed Risk Corridors Plan Level Data

templates.

Step 9 – Upload supplemental materials

Step 10 – Attest to accuracy of uploaded MLR data, Risk

Corridors Plan Level data, and supplemental materials.

The MLR Reporting Process

 Populate all cells applicable to your block of business:

 White cells indicate that data entry by the user is permitted.

 Grey cells indic

ate that no data entry is permitted. Entering data in

the gray cells will result in an upload failure.

 Green

cells indicate that a calculation by the issuer is required

according to the MLR Form instructions (values are not auto-

calculated).

Populating the MLR-A Template

 You can copy and paste blocks of data.

 When copying and pasting, s

elect the Paste Values option in order to

prevent inadvertently modifying the template. Alternatively, use the

MLR Calculator to calculate and copy data into the MLR-A template.

 Companies with QHP issuers should download and populate the Risk

rridors Plan Level Data templates to be able to complete the MLR-A

Templates. However, do not upload the Risk Corridors Plan Level Data

templates until you have successfully uploaded the MLR-A Templates.

 The d

ata entered on the Grand Total MLR-A template should be an

aggregate of the data for all states. Data for experience that is to be

reported only at the national level (Expatriate and Student Health

Plans) should be entered only on the Grand Total MLR-A template.

 Save the completed MLR-A template f

ile for upload to the MLR module.

Populating the MLR-A Template

The MLR reporting process consists of the following steps:

Step 1 – Register for the HIOS MLR module.

Step 2 – Confirm company-issuer associations.

Step 3 – Download MLR-A templates.

Step 4 – Populate MLR-A templates.

Step 5 – Upload completed MLR-A templates.

Step 6 – Download Risk Corridors Plan Level Data

templates.

Step 7 – Populate Risk Corridors Plan Level Data templates.

Step 8 – Upload completed Risk Corridors Plan Level Data

templates.

Step 9 – Upload supplemental materials

Step 10 – Attest to accuracy of uploaded MLR data, Risk

Corridors Plan Level data, and supplemental materials

The MLR Reporting Process

You must combine all completed

MLR-A templates

into a single zip file:

 CORRECT: Open the folder. Select all

Excel files. Right-click on the selected

files, choose “WinZip” and “Add to Zip

file…” option OR choose “Send to” and

“Compressed (zipped) folder” option.

Type a file name at the end of the

directory.

 Note: No spaces are allowed in the

zip file name.

 INCORRECT: D

o NOT zip the files at

the folder level. Files will fail to upload.

Combining Completed MLR-A

Templates into Zip File

Uploading the Zip File

 Select the “Upload MLR

Annual Form” tab.

 Select the “Company”.

 Select the “Reporting Year”.

 Click “Browse” and select the

zip file you created

 Click “Upload File”.

 Note: No spaces are allowed

in the zip file name.

 The system will indicate that

the MLR-A data has been

uploaded, pending validation

checks.

 All Uploaders and Attesters will receive a confirmation email

once the zip file has been uploaded successfully. The email

will identify any validation warnings.

 If the upload fails, the Uploaders will receive an email

ndicating the reasons why the upload failed.

 Once successfully uploaded, the MLR data will be ready for

attes

tation.

Upload Confirmation

The MLR reporting process consists of the following steps:

Step 1 – Register for the HIOS MLR module.

Step 2 – Confirm company-issuer associations.

Step 3 – Download MLR-A templates.

Step 4 – Populate MLR-A templates.

Step 5 – Upload completed MLR-A templates.

Step 6 – Download Risk Corridors Plan Level Data

templates.

Step 7 – Populate Risk Corridors Plan Level Data templates.

Step 8 – Upload completed Risk Corridors Plan Level Data

templates.

Step 9 – Upload supplemental materials

Step 10 – Attest to accuracy of uploaded MLR data, Risk

Corridors Plan Level data, and supplemental materials

The MLR Reporting Process

 The risk corridors plan level data form is a

separate form that is downloaded and

submitted through HIOS.

 Issuers will input some information from the

LR template on the risk corridors plan level

form, as well as premium amounts for each

QHP the issuer offers.

 The form will use this information to

aut

omatically calculate risk corridors payment

and charge amounts.

Risk Corridors

Plan-Level Data Form

 Each company with QHP issuers will be able to

access and download a risk corridors plan level

data template for each QHP issuer.

 The risk corridors plan level data template will

include

pre-populated company information,

and pre-populated 14-digit HIOS plan IDs for

each of the issuer’s QHPs that were registered

in HIOS in 2014.

Downloading Risk Corridors

Plan-Level Data Templates

 The MLR module will generate a zip file

containing all Risk Corridors Plan Level Data

template files for the selected company and

benefit year.

 If your

company has QHP Issuers and cannot

download a Risk Corridors Plan Level Data

template, please contact

ACARiskCorridors@cms.hhs.gov

 The zip file will only become available for

download after company-issuer associations

have been confirmed.

Downloading Risk Corridors

Plan-Level Data Templates (cont.)

How to Download Risk Corridors

Plan Level Data Templates

 Select the “Download

Templates” tab.

 Select the “

Company” and

“Reporting Year”.

 Click “Download Files”.

 The MLR module will generate

zip file containing pre-

populated Risk Corridors Plan

Level Data templates (named

“HHS-RiskCorridor-2014.zip”).

 Extract the c

ontents of the zip

file into a folder on your

computer.

The MLR reporting process consists of the following steps:

Step 1 – Register for the HIOS MLR module.

Step 2 – Confirm company-issuer associations.

Step 3 – Download MLR-A templates.

Step 4 – Populate MLR-A templates.

Step 5 – Upload completed MLR-A templates.

Step 6 – Download Risk Corridors Plan Level Data

templates.

Step 7 – Populate Risk Corridors Plan Level Data templates.

Step 8 – Upload completed Risk Corridors Plan Level Data

templates.

Step 9 – Upload supplemental materials

Step 10 – Attest to accuracy of uploaded MLR data, Risk

Corridors Plan Level data, and supplemental materials.

The MLR Reporting Process

Overview of the Risk Corridors

Plan-Level Data Template

 Tab 1: Individual market business

 Tab 2: Small group market business

 Tab 3: Calculates risk corridors payment or charge using

user-provided information from MLR Reporting form and

information from Tabs 1 and 2.

 Structure of Tabs 1 & 2:

 Fields for aggregate market premium

 Fields for QHP premium by HIOS plan ID

 Data on plan premium and HIOS plan ID is collected for

xchange QHPs, QHPs offered off the Exchange that are the

same as an Exchange QHP, and plans that are substantially

the same as an Exchange QHP.

Format of the Risk Corridors

Plan-Level Data Template

 You can copy and paste blocks of data.

 When copying and pasting, s

elect the Paste Values

option in order to prevent inadvertently modifying the

template.

 HIOS Plan IDs should be entered in the following format:

Issuer ID (five digits) + Issuer State Abbreviation (2

letters) + Component ID (7 digits).

 Save the c

ompleted Risk Corridors Plan Level Data

template file for upload to the MLR module. The user

must upload the company’s MLR reporting form before it

uploads the risk corridors plan level data form.

Populating the Risk Corridors

Plan-Level Data Template

 White cells indicate that data entry by the user is permitted.

 However, pre-populated Plan Names and HIOS Plan IDs

cannot be altered. Plan Names and HIOS Plan IDs entered

into section 2 (“Exchange QHPs”) of tabs 1 and 2 are

automatically copied into section 3 (“Off-Exchange QHPs”).

 Grey cells indicate that no data entry is permitted.

 Entering data in the gray cells will result in an upload failure.

 Green cells indicate that a calculation is performed in the

cell.

 No data entry is permitted as values in the green cells will be

auto-calculated.

Risk Corridors Plan-Level Data

Template Cell Coding

The MLR reporting process consists of the following steps:

Step 1 – Register for the HIOS MLR module.

Step 2 – Confirm company-issuer associations.

Step 3 – Download MLR-A templates.

Step 4 – Populate MLR-A templates.

Step 5 – Upload completed MLR-A templates.

Step 6 – Download Risk Corridors Plan Level Data

templates.

Step 7 – Populate Risk Corridors Plan Level Data templates.

Step 8 – Upload completed Risk Corridors Plan Level Data

templates.

Step 9 – Upload supplemental materials

Step 10 – Attest to accuracy of uploaded MLR data, Risk

Corridors Plan Level data, and supplemental materials

The MLR Reporting Process

You must combine all completed

Risk Corridors Plan-Level Data

templates into a single zip file:



CORRECT: Open the folder.

Select all Excel files. Right-click

on the selected files, choose

“WinZip” and “Add to Zip file…”

option OR choose “Send to” and

“Compressed (zipped) folder”

option. Type a file name with no

spaces at the end of the directory.

 INCORRECT: Do NOT zip the

files at the folder level. Files will

fail to upload.

Combining Completed Risk

Corridors Templates into Zip File

Uploading the Risk Corridors

Template Zip File

 Risk Corridors Plan-Level Data

template upload is only allowed after

successful MLR submission upload.

 Select the “Upload Risk Corridors Plan

Level Data Template” tab.

 Select the “Company” and the “Benefit

Year”.

 Click “Browse” and select the zip file

you created.

 Click “Upload File”. Note: No spaces

are allowed in the zip file name.

 The system will indicate that the Risk

Corridors Plan-Level data has been

uploaded, pending validation checks.

 A table is shown at the bottom of the

page, displaying all previously

uploaded Risk Corridors submissions.

 All Uploaders and Attesters will receive a confirmation

email once the zip file has been uploaded successfully.

The email will identify any validation warnings.

 If the upload fails, the Uploaders will receive an email

ndicating the reasons why the upload failed.

 Once successfully uploaded, the Risk Corridors Plan-

Level data will be ready for attestation.

Upload Confirmation

The MLR reporting process involves the following steps:

Step 1 – Register for the HIOS MLR module.

Step 2 – Confirm company-issuer associations.

Step 3 – Download MLR-A templates.

Step 4 – Populate MLR-A templates.

Step 5 – Upload completed MLR-A templates.

Step 6 – Download Risk Corridors Plan Level Data

templates.

Step 7 – Populate Risk Corridors Plan Level Data templates.

Step 8 – Upload completed Risk Corridors Plan Level Data

templates.

Step 9 – Upload supplemental materials.

Step 10 – Attest to accuracy of uploaded MLR data, Risk

Corridors Plan Level data, and supplemental materials.

The MLR Reporting Process

 Companies may submit supplemental materials to justify

or explain the data reported on any of the MLR-A

templates.

 Submitting supplemental materials is optional and is not

equired for attestation to the accuracy of the MLR

submission.

 You must upload the MLR-A templates before uploading

supplemental materials.

 Note: No spaces are allowed in the supplemental material

file names.

 Only PDF and MS Word documents are allowed.

Supplemental Materials

 Select the “Upload

Supplemental Materials”

tab.

 Select the “

Company”.

 Select the “

Reporting

Year”.

 Click “Browse” and select

the

supplemental material

files for upload.

 Click “Upload File(s)”.

Uploading Supplemental Materials

The MLR reporting process involves the following steps:

Step 1 – Register for the HIOS MLR module.

Step 2 – Confirm company-issuer associations.

Step 3 – Download MLR-A templates.

Step 4 – Populate MLR-A templates.

Step 5 – Upload completed MLR-A templates.

Step 6 – Download Risk Corridors Plan Level Data

templates.

Step 7 – Populate Risk Corridors Plan Level Data templates.

Step 8 – Upload completed Risk Corridors Plan Level Data

templates.

Step 9 – Upload supplemental materials.

Step 10 – Attest to accuracy of uploaded MLR data, Risk

Corridors Plan Level data, and supplemental materials.

The MLR Reporting Process

 HIOS will notify Attesters by email once the MLR data has been

uploaded and is ready for attestation.

 If the company has QHP Issuers, Risk Corridors Plan Level

data m

ust be uploaded successfully before attestation can

occur.

 If the upload(s) generated validation warnings, the Attesters and

Upl

oaders will need to determine if the data submitted is valid. If

so, the Attesters should proceed with the attestation process.

 Both the CEO Attester and CFO Attester must attest to the

curacy of the uploaded MLR data, Risk Corridors Plan Level

data, and supplemental materials in order for the filing to be

complete.

Notification that MLR Data is

Ready for Attestation

 Select the “Attestation” tab.

 Select the “

Company”.

 Select the “

Reporting Year”.

 Click “V

iew Data”.

 Select the checkbox that indicates

that

you attest to the accuracy of

the MLR data.

 Click “

Save Attestation”.

Attesting to the Uploaded Data

To recap: to file your MLR data, you will need to:

Step 1 – Register for the HIOS MLR module.

Step 2 – Confirm company-issuer associations.

Step 3 – Download MLR-A templates.

Step 4 – Populate MLR-A templates.

Step 5 – Upload completed MLR-A templates.

Step 6 – Download Risk Corridors Plan Level Data

templates.

Step 7 – Populate Risk Corridors Plan Level Data templates.

Step 8 – Upload completed Risk Corridors Plan Level Data

templates.

Step 9 – Upload supplemental materials.

Step 10 – Attest to accuracy of uploaded MLR data, Risk

Corridors Plan Level data, and supplemental materials.

The MLR Reporting Process

 MLR Reporting Form Q&A calls:

 CCIIO will address questions about the 2014 MLR

reporting form weekly, beginning May 28

through

July 30, 2015, from 2 to 3pm (EDT).

 Risk Corridors Plan-Level Data Form Trainings:

 CCIIO will hold two detailed trainings on June 1,

2015 and June 3, 2015 (1:30-3pm EDT) . The

trainings will be identical. Announcements and

registration will be conducted through RegTap.

Next Steps – Additional Trainings

 Email:

 MLR policy matters: M

[email protected].

 Risk corridors policy matters:

[email protected].

 Technical matters: [email protected] (Exchange

Operations Support Center).

 Telephone:

 Technical matters: 855-267-1515 (Exchange Operations

Support Center).

 HIOS MLR User Guide:

 Accessible on the HIOS MLR modul

e via the Related

Links and FAQ section.

Contacts & Additional Resources

2014 Medical Loss Ratio Reporting

Center for Consumer

Information and

Insurance Oversight

May 2015

Agenda

• Reporting Sequence for Companies with QHP

Issuers

• Changes to the 2014 MLR Reporting Form

• Differences between the MLR Form

and the

Supplemental Health Care Exhibit (SHCE)

• Data Aggregation

• MLR Formula Tool

• Data Validations

• Expatriate Business

• Companies with only small closed blocks of

business

Reporting Sequence for

Companies with QHP Issuers

For 2014, companies with QHP issuers will complete the MLR Form

(which includes new columns for risk corridors data), as well as the

Risk Corridors Plan-Level Data Form

– This slide does not apply to companies that did not offer QHPs

The forms should be completed in the following order:

1. Complete the MLR Form, except for the following:

– Do not complete Part 2 Line 1.11; Part 3 Lines 1.7-1.9 and Sections 5-6;

and Part 4

2. Complete the Risk Corridors Plan-Level Data Form

– Use the calculated risk corridors column values from Part 3 of the MLR

Form to complete Tab 3 of the Risk Corridors Plan-Level Data Form

3. Complete the remainder of the MLR Form

– Use the calculated values from Tab 3 Lines 9 and 10 of the Risk Corridors

Plan-Level Data Form to complete MLR Form Part 2 Line 1.11; Part 3

Lines 1.7, 3.11-3.12; and all the dependent calculations

4. Upload the MLR Forms

5. Upload the Risk Corridors Plan-Level Data Forms

2014 MLR Reporting Form Changes

Changes to the MLR Reporting Form for 2014 include:

• Added rows and columns for Risk Corridors data

• Modified calculations to incorporate payments &

harges under the Federal premium stabilization

programs (3Rs)

• Added new lines for:

– ACA section 9010 fees

– Federal transitional reinsurance, risk corridors, and risk

adj

ustment (3Rs)

– Advance premium tax credits

– Cost-s

haring reduction payments

• Moved Expense Allocation (previously Part 3) to the

end of the Form, and renumbered Parts 3-6

accordingly

• ICD-10 and Health Insurance Technology (HIT)

− The MLR Form excludes ICD-10 conversion expenses from HIT

(Part 1 Line 4.5)

− The SHCE includes ICD-10 conversion expenses in HIT (Pa

rt 1

Line 6.5)

• Community Benefit Expenditures (CBE)

− The MLR Form has a line for deductible CBE (Part 1 Line 3.2c)

and a line for all CBE (Part 1 Line 5.7)

− The SHCE has a line for deductible CBE (Part 1 Line 1.6a) and a

ine for non-deductible CBE (Part 1 Line 10.4a)

• PCORI Fees

− The MLR Form has a separate line for PCORI fees

− The SHCE includes PCORI fees in the line for federal taxes

Differences from the SHCE

• Premium Stabilization Programs / Risk-Sharing Provisions (3Rs)

− The 2014 MLR Form treats:

o Reinsurance contributions as regulatory authority licenses and fees (Part 1 Line

3.3a)

o Reinsurance payments as a reduction to MLR numerator (Part 2 Line 1.9)

o Risk adjustment net payments/charges as a net reduction/addition to MLR

numerator (Part 2 Line 1.10)

o Risk corridors net payments/charges as a net reduction/addition to MLR numerator

(Part 2 Line 1.11)

− The 2014 SHCE treats:

o Reinsurance contributions as ceded reinsurance premium in part (in Individual

market) and/or federal assessment in part (in Individual market) or in full (in Group

markets and other lines of business)

o Reinsurance payments as reinsurance recoveries (in Individual market)

o Risk adjustment net payments/charges as receivable/payable adjustments to

premium

o Risk corridors net payments/charges as receivable/payable rate credits /

retrospective adjustments to premium

Differences from the SHCE

(cont’d)

All issuers are required to aggregate three years of

experience (two years for Student Health Plans experience)

• Enter 2014 da

ta in Parts 1 and 2; Part 3 Columns CY and RC; and

Part 4 Sections 1-3

• Enter 2013 data in Part 3 Co

lumn PY1 and Part 4 Section 4

• Restate 2013 incurred claims (including reserves and the allowable fraud

reduction expense) as of 3/31/2015 in Part 3 Line 1.2 Column PY1

• Enter 2012 data in Part 3 Column PY2

• Restate 2012 incurred claims (including reserves and allowable fraud

reduction expenses) as of 3/31/2015 on Part 3 Line 1.2 Column PY2

• Aggregate data for 2012, 2013 & 2014 in Part 3 Total Column

− MLRs are calculated using aggregated data

− Rebates are calculated using only 2014 adjusted premium

Aggregating Experience

• CMS will post an Excel formula tool with built-in MLR, rebate,

and partial risk corridors calculations on the CCIIO website

• To use the M

LR Calculator, enter:

– Issue State and Federal tax exempt status in Company Information tab

– 2014 data in white cells of Parts 1 and 2

– 2012 and 2013 data in white cells of PY2 and PY1 columns in Part 3

– 2014 cost-sharing reductions and average deductible in Part 3

– If you had QHP issuers:

• Enter the amounts computed by the MLR Calculator in RC columns of Part

3, on Tab 3 of the official 2014 Risk Corridors Plan-Level Data Form

(downloaded from HIOS)

• Complete t

he entire 2014 Risk Corridors Plan-Level Data Form

• Enter t

he amounts automatically calculated by the 2014 Risk Corridors Plan

Level Data Form for MLR purposes (Tab 3, Lines 9 and 10) on Part 2 Line

1.11 and Part 3 Lines 3.11-3.12 of the MLR Calculator

MLR Calculator

• After the MLR Calculator completes calculation of the values

in all green cells, copy the data into the official 2014 MLR

reporting form (downloaded from HIOS) using one of the

following methods:

– Use the "Copy to HIOS Template” macro in the Start Here tab of the

Formula Tool to copy the entire Parts 1-5

• Note that this will overwrite any information already entered on the HIOS

template with information entered on the MLR Calculator

– OR –

– Manually copy and “paste values” into the official reporting form

• Note that you cannot paste over gray cells that divide sections or correspond

to purely descriptive lines

MLR Calculator

(cont’d)

• Submissions undergo several automated data checks in

HIOS

– Validation errors (e.g. text entered in a numeric field) must be

corrected prior to attestation

– Validation wa

rnings indicate unusual data (e.g. negative member

months) but do not prevent a user from attesting

• CMS will post the validation rules on the CCIIO website

• Warning emails

sent to the issuer only contain some of the

validation failures

• The full list of validation failures related to a particular MLR

eport can be found on the Warning and Comparison

Report in HIOS

Data Validations

• The Warning and Comparison Report is available on the

“View Uploaded Data” or the “Attestation” pages in HIOS

• The report has four tabs:

– Validation Warnings: Inconsistencies and unusual data on

a state report

– Grand Total W

arnings: Inconsistencies and unusual data

on the Grand Total report

– MLR Calculation T

ab: Discrepancies between user-entered

values and HIOS–calculated values

– SHCE/MLR-A W

arnings: Discrepancies between an

issuer’s 2014 SHCE values (as of 4/10/15) and the values

reported in the “12/31” columns of the 2014 MLR Form

Warning and Comparison Report

Companies with Expatriate Business:

• For the 2014 MLR reporting year, CMS will not enforce the MLR

rebate and reporting provisions for certain expatriate lines of

business, in accordance with the March 8, 2013 and Jan. 9, 2014 tri-

departmental guidance. Please see the Jan. 9, 2014 guidance for

the definition of expatriate plans eligible for this transitional relief:

http://

www.cms.gov/CCIIO/Resources/Fact-Sheets-and-

FAQs/aca_implementation_faqs18.html

• Companies that only have expatriate business do not need to file the

2014 MLR report

• Companies that have expatriate business in addition to other health

nsurance business should report expatriate business only in the

“12/31 Expatriate” columns on Parts 1 & 2 of the “Grand Total” form

Expatriate Business

Issuers do not have to complete all sections of the 2014 MLR

reporting form if they satisfy all of the following criteria:

1. Ceased offering health insurance coverage in every market and

state in which it is licensed to offer health insurance coverage;

2. Have o

nly grandfathered health plans in closed blocks of business

that are in run-off;

3. Are exempted by the domiciliary state from filing an S

HCE or similar

state filing;

4. Have les

s than 1,000 life years nationwide (combined for all health

insurance coverage) for the MLR reporting year; and

5. Have non-c

redible experience (using combined data from 2012,

2013, and 2014) in each state market where they provide coverage.

Small Closed Blocks of Business

Criteria

An issuer that meets all of the criteria should:

• Select “Yes” in the “small closed blocks of business” box on

the HIOS “company-issuer association” screen

• Complete only Part 3

Line 4.1 for all columns (PY2, PY1,

CY, Total) of the MLR Form in every applicable state and

market

• Use the HIOS “supplemental upload” f

unction to submit:

– Documentation of a filing exemption from the domiciliary

state

– A statement affirming that the issuer meets the small

losed block criteria

• Attest to the submission in HIOS

Small Closed Blocks of Business

Reporting

• For HIOS questions, please contact the Exchange Operations

Support Center at [email protected]

or 855-267-

1515

• For questions related to the MLR Reporting Form, please

email CCIIO at MLRQuestions@cms.hhs.gov

• For questions related to the Risk Corridors Plan-Level Data

Form, please email CCIIO at [email protected]

• CCIIO will host MLR Q&A conference calls every Thursday

from 2pm to 3pm (EDT) from May 28 through July 30

• CCIIO’s MLR website is http

://www.cms.gov/CCIIO/Programs-

and-Initiatives/Health-Insurance-Market-Reforms/Medical-

Loss-Ratio.html

Questions and Resources