The Centers for Medicare & Medicaid Services (CMS) has recently announced new requirements that will come into effect on June 18th, 2023, as part of the Affordable Care Act (ACA) Final Rule. These requirements have implications for insurance agents, brokers, and web brokers, who will need to adhere to specific documentation and review processes regarding consumer consent and application accuracy confirmation. In this blog, we aim to present a comprehensive overview of these requirements, ensuring that insurance agents and brokers are well-informed and prepared.
Please note that this blog post is provided for informational purposes only and should not be considered as legal, professional advice, or regulatory advice. For the most up-to-date information on the roles and requirements of agents and brokers in the Marketplace, it is recommended to visit CMS.gov.
1. Consent Documentation Requirements
Under the updated regulations, it is now mandatory for agents to document the receipt of consent from consumers or their authorized representatives. The following key points outline the requirements for consent documentation:
- Action for Documentation: Consumers or their authorized representatives must take an action that generates the necessary consent documentation.
- Minimum Information: The documentation should include the following details:
- Description: A clear explanation of the scope, purpose, and duration of the given consent.
- Date of Consent: The specific date when the consent was given.
- Consumer Information: The name of the consumer or their authorized representative.
- Consent Recipient: The name of the agent, or agency receiving the consent. If multiple agents or brokers within the same organization are authorized, their names should be included.
- Rescinding Process: Information on how the consumer or their authorized representative can revoke the consent.
- Maintenance Period: Agents are required to maintain the consent documentation for a minimum of 10 years.
2. Review Documentation Requirements
The updated regulations also introduce a documentation requirement for reviewing and confirming the accuracy of eligibility application information by consumers or their authorized representatives. Here are the key details regarding the review documentation requirements:
- Action for Documentation: The consumer or their authorized representative must take an action to produce the review documentation.
- Minimum Information: The documentation should contain the following information:
- Consumer Information: The name of the consumer or their authorized representative.
- Explanation of Attestations: A clear explanation of the attestations made at the end of the eligibility application.
- Assisting Party: The name of the assisting agent.
- Maintenance Period: Agents are required to maintain the review documentation for a minimum of 10 years.
3. Useful Resources
While CMS does not specify a particular format for obtaining or maintaining the consent and review documentation, as long as the aforementioned requirements are met, they provide additional resources to assist agents and brokers in fulfilling these requirements:
- CMS Model Agent Broker Consent Form: A draft model consent form developed by CMS is available for optional use. It can be accessed by downloading the ZIP file here.
- HHS Notice of Benefit and Payment Parameters for 2024 Final Rule: The final rule provides detailed information on the requirements and can be referred to for comprehensive understanding.
- Marketplace Compliance and Agent/Broker Regulations Presentation: This presentation offers further insights into compliance and regulations.
4. Conclusion
With the ACA Final Rule coming into effect on June 18th, 2023, it is crucial for agents, brokers, and web-brokers to proactively implement the necessary documentation and review processes. Compliance with these regulations is essential for ensuring transparency and adherence to statutory obligations. By familiarizing yourself with the consent and review documentation requirements and utilizing the available resources, you can navigate these changes successfully and maintain a high standard of service when assisting consumers in the health insurance marketplace.
