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CMS Key Priorities for FFM Compliance Reviews for the 2015 Benefit Year (PDF)
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]Link to more items from this source
[Guidance Overview]
Apr. 3, 2015
"CMS will perform compliance reviews of issuers offering Qualified Health Plans (QHPs) in the Federally-facilitated Marketplaces (FFM).... CMS will review data at both the issuer and the QHP level... Table A below lists the regulatory standards governing QHP certification that we anticipate including as part of the FFM compliance reviews for the 2015 benefit year.... The compliance review that is the subject of this document is separate from other audits and reviews that may be conducted to ensure compliance with the Affordable Care Act (e.g., MLR audits, policy and rate filing reviews, and reinsurance-eligible plan audits). We have provided illustrative examples, in Table B, of regulatory standards that fall into this second category of requirements that will be monitored for compliance through other review and oversight mechanism."

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