Examination Resources has been awarded a 5 year, $70M contract from the Centers for Medicare & Medicaid Services (CMS) to perform Insurance Market Reform Enforcement. ER began this work for CMS in 2012 focusing on Health Insurance Forms Reviews and Market Conduct Examinations and has completed over 20,000 compliance reviews of plan documents on behalf of the Center for Consumer Information and Insurance Oversight. Over the last 12 years, the contract has expanded to include Mental Health Parity and Addiction Equity Act Non-Quantitative Treatment Limitations Analysis Audits, and Issuer Investigations related to the No Surprises Act and Qualifying Payment Amounts under the Consolidated Appropriations Act. Additional information about this critical work and the examination reports can be found on the following website: https://www.cms.gov/marketplace/private-health-insurance/consumer-protections-enforcement
Compliance and Enforcement | CMS Ensuring Compliance with the Public Health Service ActTitle XXVII of the Public Health Service Act (PHS Act) contemplates that states will exercise primary enforcement authority over health insurance issuers in the group and individual markets to ensure compliance with health insurance market reforms. |
