Recovery of Improper Payments and Debts not applicable Key Element 4 is not applicable, because data from the Marketplace matching programs is not currently used to identify and recover improper payments and debts, as this is not a primary goal of the matching programs. Annual reconciliation and recovery of improper tax payments are performed by the IRS through a process that is independent of the Marketplace matching programs and other CMS eligibility determination activities. While the Marketplace matching programs could provide for annual and monthly reporting of data by Marketplaces to the IRS and consumers for the purpose of supporting IRS's annual reconciliation, annual and monthly reporting is not currently an activity covered in the IRS-CMS CMA; rather, that information is exchanged between the agencies through Information Exchange Agreements. At most, the data used in the Marketplace matching programs has the future potential benefit of being used in an analytical form, to assist IRS in identifying and/or recovering improper payments and debts.
Recovery of Improper Payments and Debts. Not applicable, because data from the Marketplace matching programs are not currently used to identify and recover improper payments and debts. Matching Program Structure The Patient Protection and Affordable Care Act, Public Law No. 111-148, as amended by the Health Care and Education Reconciliation Act of 2010, Public Law No. 111-152 (ACA) requires that each state develop secure electronic interfaces for the exchange of data under a matching program using a single application form for determining eligibility for all state health subsidy programs. CMS has entered into matching agreements with the following federal source agencies: 1) Social Security Administration (SSA), 2) Department of Homeland Security (DHS), 3) Internal Revenue Service (IRS), 4) Veterans Health Administration (VHA), 5) Department of Defense (DoD), 6) Office of Personnel Management (OPM), and 7) the Peace Corps. In addition, CMS has developed a matching program that is executed with every state AE, including state Medicaid and CHIP agencies and State-based Marketplaces. CMS designed the Federal Data Services Hub (Hub) to be a centralized platform for the secure electronic interface that connects all AEs and trusted data sources. Without the Hub, each State AE would be required to enter into a separate arrangement with each federal agency to determine whether applicants for state health subsidy programs are eligible for coverage. If the match operations were conducted through separate arrangements outside of the Hub, the costs to CMS, the source federal agencies, the AEs, and consumers (applicants) would be significantly greater than under the current structure. Background assumptions CMS has made the following assumptions in developing this CBA: • The ACA does not expressly mandate the use of computer matching, but effectively requires it by requiring a single streamlined application process for consumers. Because matching must be conducted to provide the single, streamlined application process Congress required (i.e., is not optional), this CBA does not evaluate whether the matching programs should be conducted versus not conducted, but rather it evaluates whether the matching programs are efficiently structured and conducted, and whether the current structure is less costly than an alternative structure. • Eight matching programs are currently operational. CMS receives data from seven source federal agencies (IRS, DHS, SSA, OPM, Peace Corps, VHA, and DoD) under separate CMAs. Under a...
Recovery of Improper Payments and Debts. No data has been developed because it is believed to be insignificant compared to improper payments avoided.
Recovery of Improper Payments and Debts. No data has been developed because it is believed to be insignificant compared to improper payments avoided. Shifting of veterans from state-funded public assistance to VA-provided benefits No data has been systematically calculated because it has been a state-developed secondary application for the match data.
Recovery of Improper Payments and Debts. Quarterly Batch Matching Operation No. of Alerts Completed by FO in FY 2015: S2 -13,568 U5 -999 Benefits S2 Wage Alert (O/P) U5 UC Alert (O/P) Retroactive Payments Percent of Records with Improper Payments 58.0% 31.0% Number of Alerts with Improper Payments 7,870 310 Average Improper Payment Amount $1,295 $1,230 Total Improper Payment (Projected) $10,191,650 $381,300 Amount Expected to Recover (65%) $ 6,624,572 $247,845 Total Benefits $ 6,872,417 CONCLUSION Costs Quarterly Batch Query Query Access to NDNH Online Database Total Key Element 1: Personnel Costs Alert Development 2,920,158 2,920,158 Overpayment Development 628,371 628,371 SSI Query Retrieval No Match Match Overpayment 7,944,372 144,761,256 9,095,544 $161,801,172 DI Query Retrieval 6,767,496 $6,767,496 Key Element 2: Computer Costs 238,537 57,300 $295,837 IAA Costs $7,385 $2,722,510 $2,729,895 Total Cost $175,142,929 Benefits Key Element 3: Avoidance of Future Improper Payments $8,103,150 $8,103,150 SSI $520,000,0000 $520,000,000 DI $396,000,000 $396,000,000 Key Element 4: Recovery of Improper Payments and Debts $6,872,417 $6,872,417 Total Benefit $930,975,567 Benefit to Cost Ratio = $930,975,567/$175,142,929 = 5.32:1 Appendix D Business Needs Assessment Chart for the Agreement between OCSE and SSA Covering SSI Quarterly Batch and Online Query for SSI, Disability Insurance, & Ticket-to-Work Activities SSA Application Match Method Function Elements Provided by SSA to Conduct Match Elements Provided by OCSE to Conduct Match SSA User Elements temporarily displayed if a match is found OCSE Databases Authority Supplemental Batch To establish and verify Individual's Social From the Quarterly Wage File: quarterly SSA claims Quarterly wage record National 42 U.S.C. § Security eligibility or payment Security number wage record identifier; for employees: personnel identifier, name, SSN, Directory of 653(j)(4), 42 U.S.C.
Recovery of Improper Payments and Debts. Data from the matching program is not currently used to identify and recover improper payments. Annual reconciliation and recovery of improper payments is ultimately performed by the IRS through a process that is also independent from CMS’s eligibility activities, including this computer matching agreement. Because data matches under this computer matching program are not used for recovery of improper payments, there are no benefits to estimate in this category. While annual and monthly reporting by Marketplaces to the IRS and consumers is a way of Marketplaces providing data to support IRS’s reconciliation, annual and monthly reporting is not an activity covered in the IRS-CMS CMA and therefore is outside the scope of this study. As these uses are not allowed under the CMAs being entered into at this time, there are currently no benefits to quantify in this category for agencies, clients or the general public.
Recovery of Improper Payments and Debts. To Agencies – • Source Agency (OCSE) – N/A • Recipient Agency (SSA) – N/A • Justice Agency – N/A To Clients – N/A To the General Public – N/A
Recovery of Improper Payments and Debts. To Agencies • Source Agency: OCSE – To be completed, as necessary, by OCSE • Recipient Agency: SSA Between October 2014 and September 2015, SSA performed approximately 7.2 million NDNH transactions, and sent 168,500 S2 and 5,679 U5 alerted cases to the FOs for additional development. The FOs worked 13,568 S2 cases and 999 U5 cases. We found retroactive overpayments in 58 percent of the S2 cases. The average retroactive overpayment is approximately $1,295. Projecting these results to the universe of S2 alerts released to the FO in FY 2015, we estimate that 7,870 cases have retroactive overpayments, with a total estimated overpayment detected from the match of approximately $10,191,650. Using the average historical recovery rate for Title XVI, we would expect to recover 65 percent of the overpaid dollars for a total benefit of approximately $6,624,572. We found retroactive overpayments in 31 percent of the U5 cases. The average retroactive overpayment is approximately $1230. Projecting these results to the universe of U5 alerts released to the FO in FY 2015, we estimate that 310 cases have retroactive overpayments, with a total estimated overpayment detected from the match of approximately $381,300. Using the average historical recovery rate for Title XVI, we would expect to recover 65 percent of the overpaid dollars for a total benefit of approximately $247,845. The total benefit for recovery of improper payments and debt is $ 6,872,417. • Justice Agencies: N/A To Clients: N/A To Third Parties: N/A To the General Public: N/A CONCLUSION These matching operations result in an overall savings of about $922,872,417 (approximately $14,975,567 for the quarterly wage batch match and about $916 million for the online query access). The total costs are approximately $175,142,929 ($3,548,529 for the quarterly wage batch match and t $168,568,668 for the online query access). These actual savings to the United States Treasury make this matching operation cost effective with a benefit to cost ratio of 5.32:1; therefore, this match is cost effective. Accordingly, we recommend the continuance of this match. COSTS
Recovery of Improper Payments and Debts. Not applicable, because data from the Marketplace matching programs are not currently used to identify and recover improper payments and debts.
Recovery of Improper Payments and Debts. Data from the Matching Program is not currently used to identify and recover improper payments. Annual reconciliation and recovery of improper payments is ultimately performed by the IRS through a process that is also independent from CMS’s eligibility activities, including this computer Matching Program. Because data matches under this computer Matching Program are not used for recovery of improper payments, there are no benefits to estimate in this category. While annual and monthly reporting by Marketplaces to the IRS and consumers is a way through which Marketplaces provide data to support IRS’s reconciliation, annual and monthly reporting is not an activity covered in the IRS-CMS CMA, or any other CMAs covered under this cost- benefit analysis, and therefore, is outside the scope of this study. As these uses are not allowed under the CMAs being entered into at this time, there are currently no benefits to quantify in this category for agencies, clients, or the general public. Attachment 2 Appropriation/TAS: ALC: BETC: DISB DUNS/BPN: Social Security Administration AGREEMENT COVERING REIMBURSABLE SERVICES JOB NUMBER CAN: SOC: SSA/ DUNS/BPN SSA TAS: SSA BETC: SSA ALC: SSA EIN: REQUESTING ORGANIZATION PROGRAM CONTACT NAME/ADDRESS FINANCIAL CONTACT NAME/ADDRESS ACCOUNTING DATA (for Government Agencies) EMPLOYER IDENTIFICATION NUMBER (EIN): BEGINNING AND ENDING DATES TYPE OF SERVICE REQUESTED PROHJECT TITLE OR KIND OF SERVICES DESCRIPTION OF SERVICES REFERENCES TO CORRESPONDENCE ON THIS MATTER: SSA PROJECT COORDINATOR NAME: OFFICE: SSA CONTACT FOR INFORMATION PERTAINING TO THIS AGREEMENT NAME: OFFICE: ESTIMATED COST AND FINANCING OF SERVICES ESTIMATED COST OF SERVICES: FINANCING (Check one): ADVANCE (in Full) PAYMENT) x Quarterly IPAC SSA AUTHORIZATION PRINTED NAME TITLE SIGNATURE DATE
