Other Items
The Model Consent Form was developed to be used by agents and brokers to meet the “the documentation of consumer review and confirmation of the accuracy of the eligibility application information requirements.”[32] Agents and forms can use the form directly, or can use as a starting point for their own consent form. A proposal was made to update the Model Consent Form to include sections related to consumer review and confirmation of accuracy of their review of Exchange eligibility requirements. The form will also have the ability to document compliance using an audio recording.
Consumers are required to file taxes and reconcile income to ensure eligibility for APTCs. Previously, HHS noted that an Exchange may only determine enrollees ineligible for APTCs if they failed to file and reconcile (FTR) for 2 consecutive years, but did not specify any required notification. They are now proposing Exchanges be required to notify enrollees or their tax filers that they have not filed and reconciled for 2 consecutive years, educating them about the process, and warning them they may lose eligibility if they do not file and reconcile.[33]
HHS is proposing to codify guidance in the document titled, ‘‘Reporting and Reviewing Data Inaccuracy Reports in State-based Exchanges Frequently Asked Questions’’. [34] Essentially when a State Exchange received adequate information regarding a discrepancy in data, they would have 60 days to make a correction.
Not all enrollees submit coverage applications themselves. Application filers are currently permitted to file applications on behalf of an applicant. However, if eligibility is contested, the applicant themselves would need to contest the eligibility determination. A proposal was made to permit an application filer to appeal a contested eligibility determination on behalf of an applicant and enrollee. [35] Applies to HHS exchange entity or State exchange entity.
While not a change to the authority, HHS proposed to make more explicit the Exchange’s authority to deny a QHP certification if it does not meet general certification criteria.[36]
An issuer interested in offering qualified health plans (AHPs) to be offered on an exchange, an annual application process is in place to ensure the plans meet all requirements. If there is a denial of a QHP in an FFE that an issuer asks to be reconsidered, a proposal indicates the burden of proof in on an issuer to provide clear and convincing evidence that HHS’ determination was in error.[37] New data would not be considered clear and convincing evidence.
[32] C. Part 155—Exchange Establishment Standards and Other Related Standards –2. Ability of States To Permit Agents and Brokers and Web-Brokers To Assist Qualified Individuals, Qualified Employers, or Qualified Employees Enrolling in QHPs (§155.220) – c. Model Consent Form Updates
[33] C. Part 155—Exchange Establishment Standards and Other Related Standards – 3. Requirement for Notification of Tax Filers and Consumers Who Have Failed To File and Reconcile APTC for Two Consecutive Tax Years (§155.305)
[34] C. Part 155—Exchange Establishment Standards and Other Related Standards – 4. Timeliness Standard for State Exchanges To Review and Resolve Enrollment Data Inaccuracies §155.400(d)(1)
[35] C. Part 155—Exchange Establishment Standards and Other Related Standards – 6. General Eligibility Appeals Requirements (§155.505)
[36] C. Part 155—Exchange Establishment Standards and Other Related Standards – 7. Certification Standards for QHPs (§155.1000)
[37] C. Part 155—Exchange Establishment Standards and Other Related Standards – 8. Request for the Reconsideration of Denial of Certification Specific to the FFEs (§155.1090)