September 29, 2022

Health

Its all about the Health

How to Use the Cost Sharing Tool

1 min read

The Centers for Medicare & Medicaid Services (CMS) provides issuers and states with a number of review tools to check QHP Application data for errors that would result in corrections following submission. The Cost Sharing Review Tool runs four different reviews to help ensure that health plans satisfy the cost sharing standards for QHP certification. These four reviews include the Maximum Out of Pocket Review, the Cost Sharing Reduction Plan Variation Review, the Standardized Option Review, the Catastrophic Plan Review, and the Expanded Bronze Plan Review. This video discusses the purpose of the tool, provides an overview of the tool’s layout, and walks viewers through running the tool using test data from the QHP Application templates. To learn more about the QHP certification process, visit www.qhpcertification.cms.gov.

The below table of contents is included for easy video navigation:
1:08 – Uploading a Populated Master Review Tool
1:40 – Using the Cost Sharing Tool
2:19 – The Maximum Out of Pocket (MOOP) Review
3:15 – The Cost Sharing Reduction (CSR) Plan Variation Review
4:37 – The Standardized Plan Options Review
5:07 – The Catastrophic Plan Review
6:08 – The Expanded Bronze Plan Review
10:41 – Example Corrections and Resolutions Part 1, Limited Cost Sharing Plan Variation and Standard Plan Cost Sharing Structure Error
12:03 – Example Corrections and Resolutions Part 2, Zero Cost Sharing Plan Variation Error
12:16 – Example Corrections and Resolutions Part 3, Successive Cost Sharing Error
More information on review tools, including the Cost Sharing Tool and Master Review Tool, visit: www.qhpcertification.cms.gov/s/Review%20Tools

News Source: CMSHHSgov

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