How to Use Data to Make Decisions & Drive Agency Performance webinar on Tues., June 30 at 2pm CT (1pm MT)

In the new landscape of care, electronic documentation is becoming critical to any agency’s survival, but a common fear of administrators is that the transition required would disrupt service delivery and take time away from clients. This session will demonstrate the contrary by focusing on the best practices of Project Renewal, which is a multi-service organization serving mentally ill and/or addicted adults in New York City, and an Organizational Member of the National HCH Council.

The presenters will offer real-world examples of how agencies are using electronic record to facilitate transparency on multiple levels, which creates more time for clients, facilitates new partnerships, and enhances the value of the agency to funders. Examples discussed will address methods of service documentation to provide key reporting for every aspect of the agency’s operations, including outcomes measurement, facilities management, Quality Assurance, and compliance with funding requirements.

Join us for this complimentary webinar, provided courtesy of our supporters at Foothold Technology, on Tuesday, June 30 at 3 p.m. Eastern.
Register Now

 

 

Center on Budget and Policy Priorities (CBPP) Guide to Special Enrollment Period Triggers and Timing

Many external organizations have developed tools, tips, materials, or training sessions that assisters can use.  We are sharing those resources through this weekly newsletter and by posting them on Marketplace.cms.gov. If you would like to recommend other helpful resources, please email CACQuestions@cms.hhs.gov.We will be limited to sharing resources that are (1) applicable to assisters facilitating enrollment in the Federally-facilitated Marketplaces (including State Partnership Marketplaces); and (2) open and accessible to the public.

Earlier this month, the Center on Budget and Policy Priorities (CBPP) created a Guide to Special Enrollment Period Triggers and Timing. The new special enrollment period (SEP) reference chart is a tool for those helping people enroll in health coverage through a SEP. It focuses on the circumstances that trigger an SEP in the Marketplace, who can trigger and use an SEP, and the effective date of coverage once consumers select a health plan. For additional resources from CBPP, such as materials from webinars, key facts, and frequently asked questions, please visit healthreformbeyondthebasics.org. 

NOTE: This section of the assister newsletter links to a non-government Web sites. We provide these links because they contain additional information that may be useful or interesting and is consistent with the intended purpose of this newsletter. We cannot attest to the accuracy of information provided by these third-party sites or any other linked site. We are providing these links for your reference. Linking to a non-CMS Web site does not constitute an endorsement by CMS or any of its employees of the sponsors or the information and products presented on the Web site. Also, please be aware that the privacy protection provided on certain CMS web sites such as Marketplace.CMS.gov does not apply to these third-party sites.

External Analysis Examines How Gaining Health Coverage Affects People’s Lives

KEY TAKEAWAY: A new analysis from the Kaiser Family Foundation offers insight into the impact that having health insurance has on adults who recently gain coverage. Its results indicate that the newly insured are more likely to have a regular source of care and are less likely to worry about their ability to afford future care than their uninsured counterparts. However, the analysis also indicates that  the newly insured continue to need help  with understanding how their coverage works.

A new analysis of the 2014 Kaiser Survey of Low-Income Americans and the ACA assesses the impact that gaining health care coverage has had on the lives of the “newly insured” adult population. Findings indicate that previously uninsured Americans who obtained health coverage experienced an improvement in access to care and a decrease in financial insecurity, though they remained concerned about cost. Additionally, newly insured adults had a similar health profile to people who already had coverage prior to 2014, and were more likely to report being in good or excellent health than their uninsured counterparts. The survey of 10,502 adults was conducted between September 2, 2014 and December 15, 2014.

  • Click here to view a news release that summarizes the survey results; click here to view the full report; and click here to view a PDF version of the report.

Additional key findings include:

  • The newly insured were more likely than those who remained uninsured to have a usual source of care (63% vs. 46%), and more likely to have a regular doctor at a source of care (44% vs. 25%);
  • The newly insured were more likely than the remaining uninsured to have used medical services (64% vs 52%), or to have had a checkup or received preventive care (47% vs 27%);
  • Although cost was the biggest factor in their choice of health plan, 44 percent of the newly insured said they had trouble affording their monthly premium;
  • However, compared to the uninsured, the newly insured report lower rates of difficulty paying medical bills (36% vs. 17%), and were considerably less likely to report living with worry about their ability to afford medical care in the future.
  • The analysis also finds that the newly insured were more likely than those who already had coverage to say they do not understand the details of their health plan, suggesting that additional education and consumer assistance may be needed.

 

NEW Slides from Complex Case Scenario – Preventing Gaps in Health Care Coverage Mini-Series: Transitioning from Employer-Sponsored Coverage to Other Health Coverage Webinar Presentation

The Friday, June 5, 2015 assister webinar included a presentation on transitioning from employer-sponsored coverage to other types of health coverage. The complex cases included in this presentation addressed how to avoid a gap in coverage and reviewed health coverage options available such as COBRA, Marketplace coverage, and Medicaid or CHIP coverage. The presentation went over some of the important details of these coverage options, including the basics of COBRA and information assisters can help consumers understand about transitioning from employer-sponsored coverage into each of these other options.

NEW Answers to Assister Questions from “An Assister’s Guide to Working with Agents and Brokers” Webinar Presentation

On Friday, April 10, 2015, the assister webinar featured a presentation on how and when assisters can work with and/or inform consumers about the services of agents and brokers. The presentation was based on this CMS tip sheet, which was released last February 2015. The April 14 assister newsletter included a summary of this presentation, along with answers to assisters’ questions addressed during the webinar. Presentation slides from this presentation can be accessed here; you can also view them along with other Guidance & regulations on assister programs here. Below are answers to additional questions that we received from assisters during this presentation; these questions are divided into three categories: A. General questions; B. Informing consumers about the services agents and brokers provide; and C. Working with agents and brokers at community events.

A.    Working with agents and brokers – General questions

Q1: What educational requirements apply to agents and brokers? 

A1:Agents and brokers participating in the Federally-facilitated Marketplace (FFM) for the individual market must complete FFM registration prior to working with consumers to assist with eligibility determinations and QHP enrollment. This process includes a mandatory annual training on the individual marketplace similar to the training that other assisters are required to complete. An outline and summary of the plan year 2015 training is available here.

Additional educational resources available to agents and brokers are posted on the “Resources for Agents and Brokers in the Health Insurance Marketplaces” page of the CMS website, which includes a newsletter for agents and brokers in the FFM that features information regarding webinars, training and registration resources, guidance and regulations, and important updates and announcements.

Q2: Are all agents and brokers that are registered with the Marketplace listed on HealthCare.gov? If so, how often is this list updated?

A2: All agents and brokers who are registered with the FFM can be found on the Find Local Help page of HealthCare.gov

Additionally, a full list of agents and brokers who have completed FFM registration for the current plan year is available on the “Resources for Agents and Brokers in the Health Insurance Marketplaces” page of the CMS website. To view this list, click on the link and scroll down to the “Agent and Broker Federally-Facilitated Marketplace (FFM) Registration Completion List,” or click here. This list contains the national producer numbers (NPNs) for agents and brokers who have completed FFM registration for the 2015 plan year. CMS posts this list twice each month, reflecting registration data as of the date of the list. All agent and broker identifying information is self-reported by the agent or broker during FFM registration, and should be validated against state and/or other NAIC records to confirm state licensure.

B.     Informing consumers about the services agents and brokers provide

Q1: Where is the best place for me to direct consumers interested in seeking out an agent or broker if I don’t have a specific list that my organization has created (using objective sorting criteria, as discussed in more detail below in Q3)?

A1: In situations when it is appropriate to inform a consumer about the services agents and brokers provide, assisters should refer to general resources that consumers can use to search for an agent or broker near where they live. Find Local Help is a great place to inform consumers about if they are interested in finding information about agents and brokers because it lists the agents and brokers who have taken Marketplace training and have registered with the Marketplace.

State Departments of Insurance might also have resources available, such as directories posted on their websites or other information available upon request. If, after the consumer looks at a general listing of agents and brokers and selects a specific agent or broker to contact, he or she asks for your help with contacting that agent or broker, you may also provide that help.

Finally, assisters can also use a web-broker site as an additional resource tool at the request of a consumer to supplement the information available on HealthCare.gov. If you do consult a web-broker site at the request of a consumer, we recommend that you educate the consumer about the fact that the web-broker site might charge a fee to access certain tools or content, or might provide limited information about some QHPs (as compared to HealthCare.gov).

Q2: Can assisters direct small business owners interested in the Small Business Health Options Program (SHOP) to an agent or broker?

A2: While Navigators and non-Navigator assistance personnel are not required to seek out small business owners to assist with SHOP enrollment, they are required to complete training on the SHOP Marketplace, and they should be prepared to help those who approach them with questions about SHOP by providing them information about resources such as the Marketplace Call Center, or directing them to another assister who can help them.

To determine when to inform a small business owner about the services agents and brokers provide , assisters should refer to guidance released in February 2015, which states that it may be appropriate to inform a consumer about services provided by agents and brokers if a consumer specifically asks about the services that agents and brokers provide and expresses a desire to talk to an agent or broker, or if a consumer expresses a desire to receive a recommendation about which plan or type of plan to choose, and if agents and brokers are permitted under state law to make such recommendations. Additionally, assisters who received a Navigator grant from a state-based SHOP-only Marketplace in a state that has a Federally-facilitated Marketplace for the individual market may be able to fulfill some of their SHOP-specific Navigator duties by making referrals to agents and brokers (please click here and scroll to page 4 for more details).

Q3: What are some other examples of “objective sorting criteria” that my organization can use to create a specific listing of agents and brokers to provide to consumers?

A3: First, it is important to note that if a consumer asks you to provide a more specific listing of agents and brokers to help him or her decide who to contact, you must apply objective sorting criteria when creating such a listing. Second, as examples of objective sorting criteria, you could generate a specific listing of all agents or brokers in a particular zip code or city and state. In addition, alone, or in combination with a geographically-targeted listing, a specific listing could include all agents or brokers that your state identifies as trained in or capable of assisting with Medicaid enrollments or that have expressed an interest in assisting consumers who come to assisters for help. Other possible objective sorting criteria might include language capability, years of experience, or a listing of agents and brokers that can sell all QHPs offered in a service area because they have a contract with all health insurers.

It is important to inform consumers who would like to see a specific listing what sorting criteria were applied, who compiled the list, and that their choices are limited based on the objective sorting criteria applied. The listing itself should not be sorted in such a manner that it gives the appearance of endorsing certain agents or brokers. For example, an alphabetical listing would be appropriate, or a listing that is based on distance from a particular location.

Q4: What should consumers do if they have a complaint or concern about an agent or broker that they work with?

A4: Consumers who have concerns about agents or brokers they work with should contact their state regulatory agency that has oversight over agents and brokers, usually the State Department of Insurance.

C.     Working with agents and brokers at community events

Q1: If an assister organization invites all agents/brokers in the area to an event the assister organization is hosting, but only a few agree to participate, is this a problem?

A1: When hosting events that include agents and brokers, the most important thing is for assisters to adhere to their duty of impartiality, not use an agent or broker as a substitute for performing any of their required duties, and not accept any direct or indirect compensation from an agent or broker.

If the assister organization extends invitations to all agents and brokers in a particular area and only some attend the event, the assister can maintain impartiality even if only some of them agree to participate by being careful not to express or imply an endorsement of, or preference for, any specific attendee.

For more guidance on working with agents and brokers at community events that includes 1) Assisters and Agents and Brokers at Events Hosted or Sponsored by Third Parties, 2) Hosting or Sponsoring Events that Include Agents and Brokers, and 3) Attending Events Hosted or Sponsored by Agents and Brokers, please see pages 7-9 of this tip sheet. Additional practical tips on this topic can also be found on slides 23-29 of this presentation.

Q2: Are agents/brokers allowed to use space in the facility where a Navigator grantee works to host their own event if the Navigator/assister is not involved in that event?

A2: Assisters must not host or reserve space for agents and brokers at your service locations, regardless of whether they are receiving any payments, services, or other consideration in exchange for the space. CMS considers hosting or reserving space for agents and brokers within an assister’s service location problematic because it would give the appearance of endorsing the particular agents or brokers who use the space. Doing so is also problematic because a consumer who comes to your service location desiring to obtain assister services might unwillingly (or unknowingly) receive assistance from an agent or broker instead.

If an assister uses an office space in a facility that is owned by a separate entity, and this entity makes space available to an agent or broker, the assister should be careful not to express or imply—by words or actions—an endorsement of or preference for the services of this agent or broker.

Q3: Can assisters contact a general agent/broker trade association that can contact a representative to attend an event that the assister will host?

A3: Assisters should consider how they can ensure a level of impartiality when inviting agents and brokers to assister-hosted public outreach, education, and enrollment events. For example, assisters should consider extending invitations to all agents and brokers in a particular area or having agents and brokers in a separate area of the event. If a select group of agents and brokers attend an assister-hosted event, assisters should be careful not to express or imply—by words or actions—an endorsement of, or preference for, the services of the group of agents and brokers that attend, or for a specific attendee.

In order to ensure that you extend invitations to all agents and brokers in your area, you should rely on comprehensive sources, such as Find Local Help, that will include all agents and brokers in a geographic area who are permitted to help with Marketplace applications. In contrast, relying on a specific broker association to determine which agents or brokers will participate in your events will not likely result in invitations to all agents or brokers available in your area to help consumers.

 

 

NEW Slides from Complex Case Scenario – Preventing Gaps in Health Care Coverage Mini-Series: Transitioning from Employer-Sponsored Coverage to Other Health Coverage Webinar Presentation

The Friday, June 5, 2015 assister webinar included a presentation on transitioning from employer-sponsored coverage to other types of health coverage. The complex cases included in this presentation addressed how to avoid a gap in coverage and reviewed health coverage options available such as COBRA, Marketplace coverage, and Medicaid or CHIP coverage. The presentation went over some of the important details of these coverage options, including the basics of COBRA and information assisters can help consumers understand about transitioning from employer-sponsored coverage into each of these other options.

 

NEW Slides from “2016 Redetermination and Re-enrollment Basics” Webinar Presentation

The Friday, June 5, 2015 assister webinar included a presentation on 2016 redetermination and re-enrollment basics. A summary of this presentation, along with answers to assisters’ questions from this presentation, was included in last week’s assister newsletter.

  • Click here to view slides from the “2016 Redetermination and Reenrollment Basics” presentation; you can also view them here along with other resources on eligibility and enrollment.

As described in last week’s newsletter, the redetermination and re-enrollment process will be similar to last year; however, there are several important changes that assisters should note:

  • The FFM will use the newest income data available to redetermine advance payments of the premium tax credit (APTC) and cost-sharing reductions (CSR) for enrollees who do not return to the Marketplace to update their application information and select a plan by December 15, 2015.
  • For the first time, the Marketplace will discontinue APTC/CSR for enrollees who received APTC but did not comply with the requirement to file an income tax return and reconcile APTC (or if the tax filer did not reconcile on the enrollee’s behalf).

Additionally, assisters can help ensure that this process goes smoothly for consumers by taking the following actions between now and the next open enrollment period:

  • Help consumers report life changes to the Marketplace within 30 days of the change.
  • Encourage consumers who received APTC in 2014 to file their 2014 federal income taxes and reconcile their APTC, even if they missed the April 15 tax filing deadline.
  • Help consumers understand the significance of checking the box at the end of the application that allows the Marketplace to request updated income information from the IRS for the next 5 years.
  • Remind consumers to return to the Marketplace during Open Enrollment in order to find the best options for their family, and make sure they’re getting the right amount of financial assistance.

For more information, assisters can check out the recently-released Guidance on Annual Eligibility Redeterminations and Re-enrollments for Marketplace Coverage for 2016. You can also refer to the May 5, 2015 assister newsletter for a longer summary of this guidance.

 

 

Public Review of Proposed Health Insurance Rate Increases for the 2016 Coverage Year

KEY TAKEAWAY: Earlier this month, CMS publicly posted rate increases for health insurance companies with proposed increases of 10 percent or more for the 2016 coverage year. These proposed increases were submitted by health insurance companies for plans inside and outside the Health Insurance Marketplaces in all states using the HealthCare.gov Marketplace enrollment platform and some State-based Marketplaces. Assisters who are interested can use the information and websites listed below to learn more about the rate review process, which allows for officials, experts, and the public to examine and question why a particular health insurance plan’s yearly increase in its premium is high.

The Affordable Care Act (ACA) requires that insurers planning to significantly increase plan premiums submit their rates to either the state or federal government for review. The threshold for this requirement is 10%. The rate review process is designed to improve insurer accountability and transparency. It ensures that experts evaluate whether the proposed rate increases are based on reasonable cost assumptions and solid evidence and gives consumers the chance to comment on proposed increases.

Earlier this month, CMS publicly posted rate increases (yearly increase in premium) for health insurance companies with proposed increases of 10 percent or more for the 2016 coverage year as part of its commitment to transparency and robust rate review.  These proposed rate increases were submitted by health insurance companies for health insurance plans inside and outside the Health Insurance Marketplaces in all states using the HealthCare.gov Marketplace enrollment platform and some State-based Marketplaces.  Rate review allows for officials, experts, and the public to examine and question why a particular health insurance plan’s yearly increase in its premium is high (10 percent or greater) before it is finalized.  The rates posted today will be finalized by October.

The ACA requires that a summary of rate review justifications and results be accessible to the public in an easily understandable format. Click here to view RateReview.HealthCare.gov, the site that is designed to meet that mandate. Click here to view a press release that includes additional information.

Summary of Benefits and Coverage Final Rule

KEY TAKEAWAY: A new regulation has been issued on the Summary of Benefits and Coverage (SBC) requirements for Health Insurance Issuers. The SBC tool is an easy-to-read summary of health insurance plan benefits and cost-sharing requirements that allows consumers to compare different health insurance plans (See a definition for SBC on HealthCare.gov). This new regulation includes several improvements to the SBC requirements that assisters should be aware of and help consumers to understand and benefit from. Please see the text below for details; there is also a link to a fact sheet that will allow you to learn more about what this new regulation means for consumers.

On Friday, June 12, 2015, the Departments of Health and Human Services (HHS), Labor, and the Treasury issued final regulations on the Summary of Benefits and Coverage (SBC). These final rules revise the current SBC regulations to make it easier for people and employers to compare their options when shopping for and renewing health insurance coverage, and they enhance the consumer shopping experience in a number of ways. For example, health insurance issuers must now provide online access to a copy of the individual coverage policy for each plan or group certificate of coverage.  And these documents must be made publicly available to all potential consumers prior to when a consumer applies for coverage, so they are clearly informed about what a plan will and will not offer.

Resources:

  • Click here for a Fact Sheet detailing consumer protections provided in these rules, and click here to view a press release with additional information on this announcement.
  • Click herefor consumer-friendly information about SBC’s on HealthCare.gov

Important Change for Health Centers with a Budget Period Start Date of December 1

Starting in Fiscal Year 2016, to ensure that all health centers have sufficient opportunity to prepare and submit their Service Area Competition and Budget Period Progress Report applications, Health Center Program grants will no longer be assigned December 1 budget period start dates.  To facilitate this transition, existing grants with a budget period end date of November 30, 2015 will receive a budget period extension for up to five months.

Impacted award recipients will be notified of this shift through an EHB email message that will refer them to a Notice of Award that will be issued in June 2015.  This Notice of Award will:

  • Reflect the new budget period end date (December 31, January 31, March 31, or April 30); and
  • Provide prorated funding to cover the timeframe of December 1, 2015 through the new budget period end date.

It is critical that award recipients take note of their new budget and project period end dates to ensure that they apply for a Service Area Competition or complete a Budget Period Progress Report at the correct time.  Cooperative agreement award recipients may direct questions or concerns to BPHCSAC@hrsa.gov.  Health centers may contact their Grants Management Specialist with questions.  The adjustment to December 1 budget period start dates will be announced publicly via Federal Register Notice.