Federal Tort Claims Act (FTCA) Risk Management Virtual Conference – Thursday, September 10, 2015, 10:00am – 3:00pm CT (9:00am – 2:00pm MT)

Join ECRI Institute, on behalf of HRSA, for this free one-day virtual conference featuring expert speakers who will walk through the practical application of risk management principles in response to an adverse clinical event. Learn how to effectively use electronic health records to manage patient care, how listening to patients can help improve patient safety, and how the processes of credentialing, privileging, clinical competence assessment, and peer review interact to improve quality.

View the full agenda for more information.

Register for this virtual conference.

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CDC Report Shows 2015 Drop in Rate of Uninsured

KEY TAKEAWAY: Recent results from the National Health Interview Survey indicate a historic drop in the uninsured rate and corresponding gains in private coverage. Assisters can see the information below to learn more, access the full summary of results, and browse reports from previous years.

Earlier this month, the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) released results from the National Health Interview Survey for the first quarter of 2015. The survey found the U.S. uninsured rate among the full population was 9.2%, the first government survey with a headline result below 10% since the CDC began monitoring this information in 1997, and a significant decrease from the uninsured rate of 14.4% at the end of 2013. Additionally, the results continue to show improvements across all demographic groups and across all different measures of uninsurance. Among those under age 65, the percentage with private coverage through the Health Insurance Marketplace or state-based marketplaces increased from 6.7 million in the last 3 months of 2014 to 9.7 million in the first three months of 2015. We would like to take this opportunity to thank assisters for your hard work, which contributed to this success!

  • Click here to view the results, “Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, January–March 2015,” and click here to access National Health Interview Survey results from previous years.

2016 Assister Training Now Available for Certified Application Counselors (CACs)

KEY TAKEAWAY: As of August 26, 2015, the 2016 Assister Training is available to Certified Application Counselors (CACs) in the Federally-facilitated Marketplace (FFM). The information below includes details on the CAC training process, and notes that the 2016 Assister Training will be available to Navigators and to agents and brokers beginning in September.

The Centers for Medicare and Medicaid Services (CMS) is pleased announce that as of August 26, 2015, the new 2016 Assister Training is available to Certified Application Counselors (CACs) in the Federally-facilitated Marketplace (FFM).  CAC training will continue to be available through Open Enrollment. However, completing this training before the upcoming Open Enrollment Period (OEP) will ensure that CACs have received the most up-to-date training to assist existing enrollees through the Marketplace redetermination and renewal process, and to help new enrollees understand, enroll, and apply for coverage in the Marketplace.  We strongly encourage CACs in FFM states to complete the 2016 Assister Training, including printing their training completion certificates by Friday, September 4, 2015.  Agent and broker training will be available in early September.  Navigator training will also be available in early September following announcement of the Navigator grant awards.

The 2016 Assister Training is hosted by the Marketplace Learning Management System (MLMS).  The MLMS replaces the Medicare Learning Network® (MLN) as an online web-based training platform for assisters providing application and enrollment assistance to consumers in Federally-Facilitated Marketplaces (FFMs), including State Partnership Marketplaces (SPMs), and certain State-based Marketplaces using the Federal platform (SBM-FPs).  The CAC training can be accessed on the MLMS through the CMS Enterprise Portal by logging in or registering as a new user at https://eidm.cms.gov/EIDMLoginApp/userlogin.jsp.

Assisters can also access training presentations and additional resources, such as Frequently Asked Questions (FAQs), MLMS Quick Reference Guides, and Help Videos at the following link: https://marketplace.cms.gov/technical-assistance-resources/training-materials/training.html.

Below are important tips for using the MLMS to complete the 2016 Assister Training:

  • The MLMS is currently experiencing issues with operating on the Internet Explorer browser.  To minimize issues with your training experience and ensure that you receive credit for the courses that you complete, you should use a recent version of a different web browser (examples: Chrome or Firefox) while we are working to resolve the issues.
  • Prepare your system before accessing the MLMS by: –  Allowing pop-up windows; –  Using the latest version of Adobe Flash which can be downloaded here: https://get.adobe.com/flashplayer/?promoid=JZEFT ; and, –  Turning on JavaScript.
  • Some organizations have security controls or software which could interfere with MLMS. If you run into issues, take your training on a home computer/laptop or public computer (such as the library).
  • The Enterprise Portal times out every 30 minutes. Click the Portal window every 28 minutes and look for a pop-up box to continue the current session.
  • Save a screen shot of the last page of the training course as proof of completion. To do so follow these steps: –  Step 1: press the PrtScn button on your computer keyboard. –  Step 2: Open the Paint windows program by pressing the Start button on your computer keyboard and clicking All Programs, clicking Accessories, and then clicking Paint. –  Step 3: Once you are in Paint, click Paste located on the Home tab.
  • If you encounter an error or your course doesn’t show complete even though you completed a course, please contact the MLMS Help Desk. Including  the following information in your email will assist the Help Desk in responding to your inquiry: –  Browser Type –  Operating System –  Print screens –  Third party security software installed –  Whether settings like Pop-up’s, Javascript, and Flash are enabled with your browser

For additional assistance with questions on the MLMS assister training, please submit inquiries to MLMSHelpDesk@cms.hhs.gov.  For assistance with CAC program questions, submit inquiries to CACQuestions@cms.hhs.gov.

Guidance for Issuers on the 2016 Reenrollment Process

KEY TAKEAWAY: CMS has published new guidance for issuers on the 2016 reenrollment process.

On August 25, 2015, CMS published a bulletin with operational guidance for issuers on the 2016 reenrollment process in the Federally-facilitated Marketplaces (FFMs), as well as in State-based Marketplaces (SBMs) that use the federal eligibility and enrollment platform. This bulletin replaces last year’s issuer guidance on reenrollment (published December 1, 2014). Important changes from last year’s guidance include:

  1. The FFM will calculate eligibility for 2016 advance payments of the premium tax credit (APTC) and cost-sharing reductions (CSRs) using the most recent family income data available and updated 2016 qualified health plan (QHP) prices (in contrast to last year’s auto reenrollment process, when 2014 APTC and CSR levels were generally carried forward for 2015).
  2. The FFM will discontinue APTC/CSRs for enrollees who do not comply with the requirement to file a tax return and reconcile APTC for tax year 2014 (see the July 29, 2015 assister newsletter for more information, or click here to view a July 17 “Update on Health Care and the 2014 Tax Season” from CMS).

We will highlight additional details from this guidance in upcoming newsletters and webinars to help assisters work with consumers renewing their coverage for 2016.

  • Click here to read Bulletin 16: Guidance for Issuers on 2016 Reenrollment in the Federally-facilitated Marketplace (FFM).
  • Click here to view the slides from our June 5, 2015 presentation on 2016 Redetermination and Re-enrollment Basics for Assisters.

NEW CMS Guidance Re-Establishes Same Timing for Renewal and Discontinuation of Coverage Notices

KEY TAKEAWAY: Last year, CMS required health insurance companies planning to discontinue a health coverage product to send notice to consumers who had this coverage at the same time that they sent renewal notices for plans that would continue. This guidance also applies to the 2015-16 Open Enrollment Period.  Assisters can help consumers understand and act on the renewal or discontinuation notices starting on November 1, 2015.

On July 7, 2015, CCIIO issued guidance for health insurance issuers regarding the timing for discontinuation of coverage notices to be sent to consumers.  Regulations require issuers to send consumers a notice at least 90 days before the coverage will be discontinued. However, in September 2014, CMS established that issuers could instead send discontinuation notices by the same date that CMS requires them to send renewal of coverage notices, which is generally before the first day of Open Enrollment. This guidance will also apply to the 2015-2016 Open Enrollment Period. Consumers enrolled in Marketplace coverage should receive either a notice that their coverage will be renewed, or a notice that their coverage will be discontinued, by November 1, 2015, the first day of Open Enrollment.

NEW: CMS Reports 950,000 Consumers Used SEPs to Enroll in 2015 Coverage from February 23 – June 30, 2015

KEY TAKEAWAY: CMS has released a report on the number of consumers who signed up for coverage on HealthCare.gov using a special enrollment period (SEP) between February 23 and June 30, 2015. This report shows that individuals and families experience changes throughout the year that make them eligible for Marketplace coverage, and that SEPs are an important tool for helping consumers avoid coverage gaps. Additionally, assisters can use the report’s “Glossary” to review the different types of SEPs available to consumers.

CMS has released a report on the number of consumers who selected a plan on HealthCare.gov using a special enrollment period (SEP) between February 23 and June 30, 2015. Nearly 950,000 new consumers in the 37 states with Federally-facilitated Marketplaces, State Partnership Marketplaces, and supported State-based Marketplaces selected a plan using an SEP during this time period. Three types of SEPs accounted for eighty-four percent of these plan selections: the loss of health coverage SEP; the tax season SEP; and the SEP for consumers who applied for Medicaid/CHIP coverage during the Marketplace Open Enrollment Period, or after qualifying for another SEP,  and were later determined ineligible.

SEP enrollees were younger than those who selected plans during the open enrollment period, which suggests that the Health Insurance Marketplace provides continuity in coverage for younger consumers as they transition between jobs, move off a parent’s health insurance plan, or experience other life changes, such as getting married or the birth of a child.

The report includes breakdowns by SEP type, age group, state, SEP activity over time, and a glossary of SEPs. This analysis of SEP plan selections shows that individuals and families experience changes throughout the year that make them eligible to get coverage through the Marketplace, and that SEPs help consumers avoid gaps in health insurance coverage.

  • Click here to view the report, and click here for more information about applying for coverage using an SEP.

OUTREACH MATERIALS: LIVING WELL TOOLKIT – PROMOTING PREVENTIVE SERVICES

CMS has released a new set of outreach and educational materials in the form of a toolkit titled Living Well, designed to help beneficiaries understand the preventive services available to them under Medicaid and CHIP. Living Well emphasizes the importance of services like regular check-ups, vaccines, and screenings to identify and prevent diseases when they are most treatable. The toolkit features a number of customizable posters, fact sheets, social media posts and graphics, and strategies that you can use for getting the word out about Medicaid coverage of preventive services.

  • Click here to view the full Living Well Toolkit, and click here to view other Outreach Tools on Medicaid.gov.

Question on HICS cases: Are you planning to give assisters the ability to view or enter Health Insurance Casework System (HICS) cases?

A1: Yes.  HICS was designed with a user profile for assisters. However, the casework and customer service environment is still evolving and we are not prepared to make it available yet to the assister community. We hope to pilot it with a small group of assisters in 2017 and evaluate its usefulness shortly thereafter to determine if we should do a broader national roll-out in the future.

New Information on HealthCare.Gov About How Consumers Can Appoint an Authorized Representative for Help Requesting an Appeal

If a consumer wants to designate an Authorized Representative –– like a family member, friend, advocate, or attorney –– to be able to ask for the appeal on behalf of the consumer and/or to speak for them in the appeal, the consumer should complete, sign and send us the Designation of Authorized Representative form you’ll find here.

Consumers can submit an authorized representative request at two different times with respect to their eligibility appeal:

  1. Simultaneously with the appeal request: Consumers can submit a written request or complete the Designation of Authorized Representative form and mail it along with their appeal request to: Health Insurance Marketplace Attn: Appeals 465 Industrial Blvd. London, KY 40750-0061
  2. After the appeal request is submitted: Consumers can appoint an Authorized Representative at any point after they have submitted their appeal request. To do so, after submitting an appeal they should submit a written authorized representative request or complete the Designation of Authorized Representative form and mail it to: Marketplace Appeals Center P.O. Box 311 Pittson, PA 18640

Click here for more information about how to appoint an authorized representative, including what information consumers should submit with their written requests.

Consumers Can Now Mail or Fax the Marketplace Their Completed Appeal Request Forms

CMS has recently added an additional way for consumers to submit a request to appeal Marketplace decisions. Consumers can now fax their appeal requests into the Marketplace, in addition to sending an appeal request by mail. See below for information on how to fax in an appeal request and for how to mail in an appeal request.

Here are the ways consumers can request a Marketplace eligibility appeal:

  • Consumers may write an appeal request in the form of a letter or complete an appeals request form for their state of residence.
  • They can mail their appeal request to: Health Insurance Marketplace Attn: Appeals 465 Industrial Blvd. London, KY 40750-0061
  • Alternatively, consumers may fax an appeal request to this secure fax line: 1-877-369-0129

Regardless of how a consumer chooses to submit a Marketplace eligibility appeal request, it is always helpful to explain why the appeal is being requested and to attach the eligibility determination notice that the consumer is appealing.

Click here for more information on Marketplace appeals, including which Marketplace decisions can be appealed.