BPHC is hosting this webinar to discuss PAL 2015-02 “Accreditation and PCMH Recognition Initiative” (outlined in the “What’s New” section of the Digest) and the new notice of intent process. This is an important session for health centers interested in receiving HRSA support in pursuit of national quality recognition.

View the webcast the day of the session. Connect to the audio line using 1-888-790-3418; Participant passcode: 9569850.

BPHC released PAL 2015-02 which describes the Accreditation and Patient Centered Medical Home Recognition Initiative, and outlines the process and requirements for applying for ambulatory health care accreditation and/or patient centered medical home (PCMH) recognition in 2015.

View more information on PAL 2015-02.

HRSA requires all 340b covered entities to annually recertify their program information in order to continue participation in the 340b Program. Recertification is open through March 11, 2015. It is critical that health centers recertify before the deadline in order to continue participating in the 340b Program.

Recertify your health center’s 340b information.

View 340b Program resources.

Contact the 340b Prime Vendor Program with any questions on the recertification process.

Consumers who signed up for Marketplace coverage last year should have received a statement in the mail in February from the Marketplace called a Form 1095-A.  Most consumers can also download a copy of their 1095-A through their HealthCare.gov account.  This statement includes important information for consumers to complete and file their tax returns. One piece of information included in the 1095-A is the premium amount for the “second lowest cost Silver plan” in the consumer’s area.  This premium amount represents the benchmark plan we use to determine the amount of premium tax credit consumers were eligible to receive.

We have been urging consumers to check the information on their forms for accuracy; people who find errors on their form can contact the Marketplace Call Center at 1-800-318-2596 to find out how to request a corrected form.

Last week, CMS released an important update, “What Consumers Need to Know about Corrected Form 1095-As,” indicating that about 20 percent of the tax filers (about 800,000 consumers) who had FFM coverage in 2014 and used tax credits to lower their premium costs  will soon receive an updated Form 1095-A because the original version they were issued listed an incorrect benchmark plan (second lowest cost Silver plan) premium amount. Based upon preliminary estimates, approximately 90-95% of these tax filers have yet to file their tax returns.  We are advising these consumers to wait until they receive their new form or go online for correct information before filing. Impacted  consumers should receive their new forms by the first week in March. For those who have filed their taxes — approximately 50,000 (less than 0.05% of total tax filers) – the Treasury Department will provide additional guidance soon.

It’s important to note that this issue does not affect the majority of Marketplace consumers and affects only people who signed up through one of the 37 states using HealthCare.gov. You can see which states are in the FFM here. About 80 percent of Marketplace consumers who received a Form 1095-A from the federal Marketplace are unaffected, and should go ahead and file their annual tax return. Additionally, this issue does not mean that consumers received the incorrect amount of tax credit throughout the year.

Our priority is to make sure people with affected forms are alerted to the issue and are made aware of the steps they need to take. If you are working with a consumer whose form was affected, he or she will receive a phone call from the Marketplace by early March, in addition to letters and emails with additional information about the status of his or her form.

We encourage assisters to remind consumers concerned about whether or not their Form 1095-A was affected to take the following steps:

  1. Log in to their account at HealthCare.gov. Consumers will see a notice message that will let them know if their form was or was not affected. A majority of tax filers with Marketplace coverage through HealthCare.gov that received a 1095-A– about 80 percent – will find that their form was not affected by this issue and will be able to file their taxes with their current form.
  2. Wait to file their taxes if their form was affected. It’s best for consumers to wait to file their tax return until they receive their corrected Form 1095-A  from the Marketplaces. New forms are being sent from the Marketplace beginning in early March. When the corrected form is ready, we’ll also send a message to the consumer’s Marketplace account on HealthCare.gov.
  3. Use the Marketplace tool if a consumer needs to file now. If a consumer can’t wait to file their tax return, and wants to find the correct amount of the second lowest cost Silver plan that applied to their household in 2014, consumers have 2 options: 1) use this tool to find that amount, or 2) call the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325) and they can help.

Resources with more information:

As assisters, you can help consumers seeking to take advantage of the special enrollment period (SEP). CMS launched the 2015 Special Enrollment Period (SEP) Screener Tool on February 16, 2015.  Assisters can use this tool to help consumers determine whether they are eligible for an SEP to enroll in 2015 health insurance coverage through the Marketplace or Medicaid/CHIP. For most people, the last day to enroll in a 2015 Marketplace plan was February 15, 2015 (or February 22, 2015 for those consumers who qualified for the “in-line” SEP); but in some cases, consumers may still be able to get coverage this year. In the Marketplace, consumers may qualify for a SEP 60 days following certain life events that involve a change in family status (for example, marriage or birth of a child) or loss of other health coverage. Employer sponsored plans must provide a SEP of 30 days. You can view additional information about SEPs on the HealthCare.gov page, “Getting 2015 Coverage with a Special Enrollment Period.”


Last Friday, February 20, 2015, CMS announced a special enrollment period (SEP) for individuals and families in states which use the Federally-facilitated Marketplaces (FFM) who did not have health coverage in 2014 and are subject to the fee or “shared responsibility payment” when they file their 2014 taxes. This SEP will allow individuals and families who were unaware or didn’t understand the implications of this new requirement to enroll in 2015 health insurance coverage through the FFM.

For those who were unaware or did not understand the implications of the fee for not enrolling in coverage, CMS will provide an opportunity to purchase health insurance coverage from March 15 to April 30. If eligible consumers do not enroll in coverage for 2015 during this SEP, they may have to pay a fee when they file their 2015 income taxes.

Those eligible for this SEP must live in states with a Federally-facilitated Marketplace and meet the following conditions:

  • Currently are not enrolled in coverage through the FFM for 2015;
  • Attest that when they filed their 2014 tax return they paid the fee for not having health coverage in 2014; and
  • Attest that they first became aware of, or understood the implications of, the Shared Responsibility Payment after the end of open enrollment (February 15, 2015) in connection with preparing their 2014 taxes.

The special enrollment period will begin on March 15, 2015 and end at 11:59 pm EST. on April 30, 2015. If a consumer enrolls in coverage before the 15th of the month, coverage will be effective on the first day of the following month.

Note that individuals taking advantage of the SEP for tax season will still owe a fee for the months they were uninsured and did not receive an exemption in 2014 and 2015. The SEP is designed to allow such individuals the opportunity to get covered for the remainder of the year and avoid additional fees for 2015. For more information you can refer to the press release.

Since Open Enrollment for the Health Insurance Marketplace began on November 15, 2014, about 11.4 million people have explored their options, learned about the financial assistance available, and signed up for or renewed a health plan that meets their needs and fits their budget. This fact sheet, updated since last week, provides a point-in-time estimate as of February 15, 2015 of the many numbers behind the 2015 Open Enrollment Period.

Like last year, consumers who apply for coverage through the Marketplace or with their state Medicaid agency during Open Enrollment, and are found ineligible for Medicaid or the Children’s Health Insurance Program (CHIP), may be eligible for a special enrollment period (SEP) which will allow them to enroll in coverage on the Marketplace after the Open Enrollment Period has passed.

This includes both:

  • Consumers who applied for coverage at the FFM during Open Enrollment, were assessed eligible for Medicaid or CHIP, and were later determined ineligible for Medicaid or CHIP by their state Medicaid or CHIP agency.
  • Consumers who applied at their state Medicaid or CHIP agency during Open Enrollment and were determined ineligible for Medicaid or CHIP by their state Medicaid or CHIP agency.

After being determined ineligible for Medicaid or CHIP, consumers can come to the Marketplace by visiting www.HealthCare.gov or by calling the Call Center to fill out or complete an application for coverage in a Qualified Health Plan (QHP). Consumers will need to indicate that they have been found ineligible for Medicaid or CHIP and that they applied for coverage during Open Enrollment (between November 15 and February 15).

Alternatively, after being determined ineligible for Medicaid or CHIP, most applications are transferred from the state Medicaid agency to the Marketplace. Once the Marketplace receives the application, it will notify the consumer, inviting consumer to come in and pick-up and complete a pre-populated application.

Upon completing their Marketplace application and being determined eligible for QHP coverage, consumers will be determined eligible for a SEP.  Remember if you qualify for a SEP to change plans or enroll for the first time, you’ll have 60 days from your Medicaid or CHIP determination date to enroll.

As assisters you may have heard from or worked with consumers who were unable to enroll in coverage through the Federally-facilitated Marketplace (FFM) at the end of the current open enrollment period due to certain circumstances they experienced in the process. Certain circumstances across consumer enrollment channels (such as HealthCare.gov and the Marketplace Call Center) leading up to the February 15, 2015 deadline. These circumstances may have kept some consumers from completing the enrollment process despite their efforts to meet the deadline.  Consumers may also qualify for a special enrollment period (SEP) to enroll in coverage outside of Open Enrollment under certain circumstances, for example life changes or errors in enrollment.

As a result, CMS will provide a SEP to consumers who meet the following three conditions:

1. Are new enrollees for 2015 coverage who are not currently enrolled in coverage through the FFM

2. Have not been terminated from coverage through the FFM during the 2015 Open Enrollment Period, and

3. Attest that they tried to enroll during the annual Open Enrollment period but did not complete the process (referred to as being “in line”) by February 15, 2015 because they experienced a technical issue with HealthCare.gov that prevented them from completing enrollment by February 15 or an extensive call center wait on February 13, 14 or February 15.

The SEP for “in line” consumers will start on February 16, 2015 and end on February 22, 2015.  Enrollments completed during this SEP will have an effective date of March 1, 2015 to align with the effective date eligible consumers would have had if they had been able to complete the enrollment process by the February 15, 2015.   Consumers can qualify for this SEP if they meet the criteria above and attest on their Marketplace application that they tried to enroll in coverage during Open Enrollment but did not complete the process by the February 15deadline.  Consumers can qualify for this SEP online by visiting HealthCare.gov, or by calling the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325). Once consumers have enrolled in a plan they should contact the insurance company to ask when their first premium is due. Note, that consumers will not be able to access this SEP through the direct enrollment process with issuers. Guidance was also shared with assisters on a marketplace update sent on February 16, 2015.     

More info on this SEP is included in this blog in English and in Spanish. Also HealthCare.gov also includes a new alert on the website which includes a blue box which states “Important: If you tried to enroll by 2/15, but couldn’t finish, you may still be able to get 2015 coverage.”



Register for the webinar using this link | To Join By Phone Only:1 (562) 247-8321, Access Code: 172-763-629, Pin Number is the # key.

The health care law has created special enrollment periods for those who experience special circumstances such as graduating from college and losing health insurance, getting married and needing coverage for a spouse, losing employer insurance or turning 26 and losing coverage on a parent’s health plan. Join this webinar to learn more about special enrollment periods and how to enroll in the Health Insurance Marketplace. For those who are uninsured and don’t qualify for the special enrollment period, you can learn what resources are available and when to enroll in the Health Insurance Marketplace.