Hey there, awesome marketplace agents and brokers! We've got some news to share, hot off the press from the recent CMS Summit. CMS (Centers for Medicare & Medicaid Services) has rolled out new rules and guidelines when it comes to consent and review for marketplace enrollments. Here are the slides from the summit!
Applicability: Generally, this applies to states using Healthcare.gov. If you are in a state exchange, check with your state for additional guidance, as they may have adopted some of the provisions of these requirements.
Let's dive in, shall we?
✅ Consent Documentation Requirements ✍️
Effective 6/18/2023 brokers are now required to document active consent BEFORE accessing a consumer's account through the federal marketplace. This is what needs to be documented:
🔵 The consumer, or their authorized representative, must take an action to produce the documentation. 📝
🔵 Provide consumers with a process to rescind consent if they need to. If you do your job, this will never be an issue, but it gives your clients and regulators the confidence that they have a parachute on their back! 🪂
🔵 You must ensure transparency by clearly describing the scope, purpose, and duration of the consent provided by the consumer or their authorized representative. 🔍
CMS did not specify one standard for documenting consent. If all of the above are captured in a call recording, physical form signed, email document, or text document, then you are in compliance. Whatever you do, you must include the above information. ✒️
📄 CMS drafted a model consent form here. Personally, we feel the CMS model is a bit overwhelming and technical, both for the broker and consumer. The goal of these new rules is informed consent. We are confident that having a form designed for efficient understanding by all parties is crucial, especially when OEP is already not long enough to achieve everything that we are tasked to do!
📄 As the Chairman of the Individual Markets Work Group for NABIP, our CVO, Joshua Brooker, drafted a paper broker consent form for NABIP members that was reviewed by CMS/CCIIO and is compliant and in layman's terms here.
💻 For digital capture, if you are looking to delegate the setup and upkeep of your own solution, you can sign up for our e-consent form here.
✅ Review Documentation Requirements 📋
Maintain documentation stating a consumer or their authorized representative has reviewed and confirmed their application information is accurate (45 C.F.R § 155.220(j)(2)(ii)(A)(1)-(2)). (Referred to as “Review Documentation Requirements”);
🔵 It's crucial to maintain documentation confirming that a consumer, or their authorized representative, has reviewed and confirmed their application details, before you click submit on the eligibility application. ✅
🔵 If you use a DE/EDE personalized URL, and the consumer uses your link and enrolls themselves, you are good to go.
🔵 If you get to the summary document of the application, and you have the individual review it and attest that it is complete, then this requirement is also met.
🔵 The documentation should include the date of review, the consumer's name, an explanation of the eligibility application attestations, and the name of the assisting agent, broker, or web-broker. 📅
🔵 Just like most retention requirements, make sure you keep this documentation for a minimum of 10 years. 🗂️
These new documentation requirements went into effect on June 18th, 2023. Don't worry about past applications, these rules won't apply retroactively. However, moving forward, it's in your best interest to embrace these practices and ensure compliance. Stay tuned for Clarifying FAQs from CMS, providing further guidance. We're here to support you every step of the way! 📆
Remember, these rules on consent and client review are designed to protect both your clients and your relationship with them. By following these guidelines, you'll maintain a high level of professionalism and trust. Let's turn this into an opportunity for growth and improvement! 💪💙
As mentioned, if you are overwhelmed, we are happy to help with our digital solution. Learn more here.
If you have any questions or comments, we're here for you! Reach out via hello@mysnaphealth.com, and we'll prioritize your requests accordingly. We're in this together, and together we'll make compliance a breeze! 👥💫
We’re committed to the role of brokers helping brokers!