The Department of Health and Human Services is proposing to make some significant changes to the rules governing the Affordable Care Act, including a shortened time period for open enrollment and additional requirements that could affect brokers.
The Centers for Medicare & Medicaid Services late Friday issued a
Under the rule, HHS also proposes to oversee the training of brokers and agents who wish to work in the marketplaces, including approving and overseeing vendors that provide training to agents and brokers in the federally-facilitated marketplaces, as well as perform information verification functions such as identity proofing. The agency also suggests that to become an HHS-approved vendor, the organization must demonstrate that it meets specified criteria pursuant to an approval process established by HHS.
In turn, HHS would recognize the successful completion of an exchange training program from an approved vendor as sufficient to satisfy the requirement to receive training in the range of qualified health plan options and the insurance affordability programs.
One of the rules other proposals would require that all government-run ACA exchanges, qualified health plan insurance plan issuers and Web-based health insurance brokers provide telephonic interpreter services in at least 150 languages.
HealthCare.gov already meets that standard in its own call center, but some state exchanges and brokers could be challenged to come into compliance with such a requirement.
Improved transparency
The rule would also require insurance providers to list all current medical providers in their plan networks on the insurer's public website, including information on which providers are accepting new patients. Insurers would be required to update the list on a monthly basis and make it available to the general public in a manner that is easily accessible.
CMS is working to improve the consumer experience and promote accountability, uniformity and transparency in private health insurance, says CMS Administrator Marilyn Tavenner.
Another proposal of the rule would default current enrollees to lower-priced plans during future open-enrollment periods. Under current rules, consumers who take no action during the open enrollment period are typically re-enrolled in the same or similar plan they were enrolled in during the previous year, regardless of whether the plan has experienced significant premium increases. The proposed rule would give individuals the option of being defaulted into a lower cost plan rather than their current plan.
While such a default could help consumers avoid surprise premium hikes, theres no guarantee the new plan will cover the same doctors and other medical professionals.
The rule also proposes to improve consumer access to medications not included on a plans formulary, by proposing a detailed process by which individuals can request an exception for coverage. The rule would also require an external review of an exception request if the health plan denies the initial request.
Cost-sharing for drugs obtained through the exceptions process would also be required to count towards the plans annual limitation on cost-sharing, the rule proposes.
The rule also proposes to shorten the annual open enrollment period for 2016 and beyond. The annual enrollment period would begin Oct. 1 and run through Dec. 15 of the year prior to the benefit year. The truncated enrollment period would be at least two weeks shorter than 2015 open enrollment which kicked off Nov. 15 and runs through Feb. 15.
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