Office of Consumer Information and Insurance Oversight
CCIIO provides additional guidance on Navigators and Marketplace assistance
Posted on May 17, 2013
The Center for Consumer Information and Insurance Oversight (CCIIO) issued additional information on navigators and other consumer assistance and outreach programs provided by the Affordable Care Act (ACA). The document expands upon the standards with which these assistors must comply, available grant funding, and the differences between the assistance programs.
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CCIIO releases Marketplace FAQ
Posted on May 17, 2013
The Center for Consumer Information and Insurance Oversight (CCIIO), a division of the Centers for Medicare and Medicaid Services (CMS), recently posted new guidance concerning federally-facilitated and state-based Exchanges (Marketplaces) established under the Affordable Care Act (ACA). The guidance purports that if states do not adhere to and enforce the requisite standards for health insurance issuers in federally-facilitated Exchanges, then CMS intends to coerce enforcement through civil penalties and plan decertification. CMS does not believe that decertification will be a common occurrence. In addition, the guidance stated that qualified health plans (QHP) paired with health savings accounts (HSA) must meet the cost-sharing reduction standards that apply to low income-individuals.
CCIIO published additional guidance that expands upon which activities, in both federally-facilitated and state-based Marketplaces, that qualify for grant funding under ACA Section 1311. For instance, state-based Marketplaces are not permitted to use this funding for navigator outreach and education, yet they are allowed to use Section 1311 funds for “in-person assistance programs.”
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CCIIO will amend Exchange regulations for Utah
Posted on May 10, 2013
In a letter addressed to the governor of Utah, Center for Consumer Information and Insurance Oversight (CCIIO) Director Gary Cohen stated that CCIIO will release updated regulations that will permit Utah to operate their small business health option program (SHOP) while the federal government runs the individual Exchange. The letter addresses how Utah and the federal government will divvy up responsibilities concerning navigators and plan management, as well as data reporting requirements for their SHOP. In addition, the letter purports that other states may also pursue a similar Exchange model.
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CCIIO provides Model Language for issuers
Posted on May 8, 2013
The Center for Consumer Information and Insurance Oversight (CCIIO) provided permissible Model Language for issuers to use when notifying existing customers of the new plan options that will be available to them through the Affordable Care Act’s (ACA) health insurance marketplaces. CCIIO provided several examples as to how issuers may phrase their notices, and gives issuers the flexibility to either provide the notice by itself or as part of the customer’s policy renewal notice. Furthermore, issuers of qualified health plans (QHP) and non-grandfathered health plans are barred from using practices that would discourage enrollment of those with poor health statuses.
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CCIIO issues agent and broker guidance
Posted on May 2, 2013
The Center for Consumer Information and Insurance Oversight (CCIIO) released new guidance detailing the roles of agents, brokers and web-brokers in the health insurance Exchanges. The letter claims that State-Based Exchanges may establish their own regulations on the amount insurers can pay brokers, while Federally-Facilitated Exchanges, which also includes State-Partnership Exchanges, will not create commission schedules or pay commission directly to the brokers. CCIIO also purported that they will re-evaluate the requirement that brokers receive the same compensation for selling plans outside of the Exchanges as they would for selling qualified health plans (QHP). Brokers are anticipated to play a role in educating consumers entering into the Exchange, and the Centers for Medicare and Medicaid Services (CMS) will be responsible for registering and training agents and brokers to help consumers in the QHP selection process. States, however, will retain the authority to license and regulate brokers and agents.
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CCIIO releases FAQ on market reforms
Posted on April 29, 2013
The Center for Consumer Information and Insurance Oversight (CCIIO) released a set of eight questions on implementation of the Affordable Care Act (ACA). Specifically, this guidance clarifies the limitation provided in the Market Rule final rule stating that a plan issuer may have one geographic rating factor for each approved geographic rating area per single risk pool in a given state. The following topics are addressed in the FAQ to expand upon the meaning of this limitation:
- Withdrawal of non-grandfathered business
- Maintenance of alternative mechanisms
- Geographic rating areas
- Definition of association coverage
- Premium adjustment when coverage becomes secondary to Medicare
Issuers submitting plans to the federally-facilitated Exchanges may make necessary changes to their plans in order to comply with this new guidance.
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CMS issues guidance on exchange participation
Posted on March 27, 2013
The Centers for Medicare and Medicaid Services (CMS) released a draft letter to issuers regarding Federally-facilitated and State Partnership Exchanges. This guidance letter offers technical and operational guidance that will permit Qualified Health Plan (QHP) issuers to operate successfully in Federally-facilitated Exchanges and Federally-facilitated SHOPs, including State Partnership Exchanges.
One specific resource addressing requirements presented in this letter is a database of essential community providers (ECPs). ECPs treat low-income individuals in medically underserved areas. Although non-exhaustive, this database is designed to provide CMS an estimate regarding the number of ECPs in a QHP’s service area.
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Feds release ACA regulation roundup
Posted on March 1, 2013
The US Department of Health and Human Services (HHS) has released a flurry of regulations implementing various aspects the Affordable Care Act (ACA) today, including insurance market rules and rules related to the small business exchanges (SHOP). Additionally, both the Internal Revenue Service (IRS) and the Office of Personnel Management (OPM) have released ACA regulations. A list of the rules is…
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CCIIO releases FAQ on state plan management
Posted on February 21, 2013
According to a Frequently Asked Questions (FAQ) guidance posted by the Center for Consumer Information and Insurance Oversight (CCIIO), states can determine whether health insurance plans qualify for the online health insurance exchange markets and conduct other plan management activities without submitting a “blueprint” application to the Department of Health and Human Services (HHS). The blueprints are applications that must be submitted to HHS in order for states to operate state-based exchanges or to participate in a state partnership exchange under the Affordable Care Act (ACA).
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HHS releases single streamlined insurance marketplace application, solicits comment
Posted on January 29, 2013
The Centers for Medicare and Medicaid Services (CMS) has released a draft of the single, streamlined applications for both individual health insurance coverage and the SHOP applications, in preparation for the launch of the new Health Insurance Marketplace (formerly known as the Exchange) next fall. Model applications and documentation for individuals and for the small business health options program (SHOP) are now available for public comment via the paperwork reduction act (PRA).
The individual application is a single point of entry to purchase private insurance through the Marketplace and assess eligibility for assistance, including Medicaid, CHIP, and the Advanced Premium Tax Credits (PTCs). CMS has asked that people review the paper and online applications and provide feedback in the way of comments, which can be done by accessing the documents at the PRA website here.
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- State Health Insurance Exchange Navigators posted on February 28, 2011
- CMS State Resources FAQ: Medicaid Eligibility Determinations, Medicaid/Exchange Interactions, and §1115 Demonstrations that Use Enrollment Caps posted on May 22, 2013
- Reform Overview posted on April 12, 2010
- The QHP Certification Process in Federally-Facilitated Exchanges: Network Adequacy and Essential Community Providers posted on March 27, 2013
- Update: Essential Health Benefits Final Rule posted on March 13, 2013
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