Obamacare FY14 Budget: ‘To Ensure Integrity of Programs That Redistribute Tens of Billions’

By Terence P. Jeffrey | October 31, 2013 | 3:32pm EDT

President Barack Obama and HHS Secretary Kathleen Sebelius. (AP Photo/Ron Edmonds)

(CNSNews.com) - The fiscal 2014 budget justification released by Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner explains that CMS is requesting that Congress appropriate $803.5 million for operations and management of the Obamacare exchanges during the fiscal year so that, among other things, CMS can “ensure the integrity of programs that redistribute tens of billions of dollars.”

Overall, CMS wants $2 billion to run what it calls the “Federal Marketplace” for health insurance. “CMS’ program level request for the Marketplaces totals $2.0 billion in FY 2014, to support the first year of program operations,” says the budget justification. The agency estimates $1.5 billion of that will come from “discretionary Program Management resources” and $450 million from “anticipated user fee collections.”

The “Operations and Management of Marketplaces’ subsection of the justification says that CMS intends to spend $803.5 million in this area. That includes money that will be spent on “data mining techniques” to make sure the right people are benefiting from the new system of health-insurance subsidies set up by the Affordable Care Act.

“To ensure the integrity of programs that redistribute tens of billions of dollars,” says the budget justification, “CMS must have robust systems to audit and/or validate user fees, calculations of cost-sharing reductions, advance payment of premium tax credits, reinsurance, risk corridors, and risk adjustment, carefully track operational data and metrics (e.g. reinsurance payments, payment parameters, audit methodology, populations, etc.) across the three market stabilizing programs and the Marketplaces, as well as to implement and maintain a fraud surveillance program to prevent and detect fraud, waste, and abuse. CMS will use proactive measures including data mining techniques and other analytic activities to detect anomalies that may be indicators of fraudulent activity.”

The section of the budget justification dealing with CMS’s IT expenditures says one purpose of these expenditures will be to make sure CMS can warehouse and data mine information it collects through the Obamacare “Marketplaces.”

The subsection headlined “CMS ACA IT” says: “This request supports Marketplace implementation and other IT needs.

“--Data Warehousing: Provides data analysis and technical expertise to enable CMS to host data, conduct data mining and data analysis functions for the Marketplaces.”

“In FY 2014 and later years,” says the budget justification. “CMS intends to collect information on consumer choice of health insurance plans and eligibility for advance premium tax credits and cost-sharing reductions in the Federal Marketplace. In addition, in FY 2014 CMS will track enrollment in private health insurance--including Marketplace enrollment - and Medicaid to inform the Department’s overall tracking of the percent of the population that remains uninsured.”

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