On February 24, 2016, CMS announced a new Special Enrollment Confirmation Process.

Once the new Special Enrollment Confirmation Process is implemented, all consumers applying through the most common HealthCare.gov special enrollment periods (SEPs) will be directed to submit documentation to verify their eligibly to use an SEP. CMS will then review the documents to ensure consumers qualify for an SEP.

On March 4, 2016, CMS updated the Marketplace application by:

  • Adding New Attestation Language: New language requires consumers to attest that they understand they may be asked to provide additional information, including proof of their eligibility for an SEP, and that, if they do not provide proof of eligibility, they may face penalties including the risk of losing their coverage. This box is on the privacy policy page of the application and must be checked prior to proceeding through a new or updated application and entering information that may qualify the consumer for an SEP.
  • Updates to Loss of Minimum Essential Coverage Questions: Both the recent loss of coverage and future loss of coverage questions have been updated to (1) specify that coverage must have been lost within the past 60 days or will be lost within the next 60 days; (2) provide examples of coverage that qualifies as minimum essential coverage (MEC); and (3) provide a link to a help page that provides a thorough discussion and explanation of MEC. In addition, new blue boxes have been added to clarify that losing coverage due to nonpayment of premiums does not qualify as loss of MEC for purposes of qualifying for this SEP.
  • Updates to the Permanent Move Question: The permanent move question has been updated to specify that the move must have occurred within the last 60 days and provide examples of which situations do and do not qualify as a permanent move for purposes of qualifying for this SEP.

Additionally, CMS updated text on the SEP Screener Tool to reflect these application updates. These application updates will be accompanied by other improvements to the SEP application process, which are described here and are part of the new Special Enrollment Confirmation Process.

Refer to this Fact Sheet for further information on how the Special Enrollment Confirmation Process will work and what else CMS is doing to improve the SEP process.

Key Takeaways: CMS has temporarily suppressed the “authorized user” page that was previously available in a consumer’s My Account. Consumers cannot currently appoint formal authorized representatives through either the online or paper applications. Help consumers understand the two different types of representatives (authorized representatives vs. third-party representatives) so they can make informed choices about who speaks or acts on their behalf.

Because of a system defect, consumers cannot currently appoint formal authorized representatives through either the online or paper applications. To avoid confusion, the “authorized user” page won’t be visible until CMS can fully implement the appropriate functionality. This does not affect the information that consumers enter about who assisted them in the application.

As a reminder, for Call Center purposes only, a consumer can designate an individual as a third-party representative to communicate with the Marketplace Call Center on the consumer’s behalf. Please refer to slides 13 and 14 of the How Assisters Can Help Consumers Apply for Coverage through the Marketplace Call Center presentation for information on how consumers can designate someone to speak to the Call Center on their behalf. Communicate to consumers that the major difference between allowing an assister to act as a third-party representative and the designation of an authorized representative is that acting as a third-party representative does not allow the assister to make decisions on behalf of the consumer, which includes selecting a plan or filing an appeal on behalf of the consumer.

These roles are not interchangeable, so if a consumer designates someone to act in one capacity—in an appeal, for example—it does not mean that person has been designated in another capacity—such as to communicate with the Marketplace Call Center. Each type of designation must be done separately, and consumers may not want the same person in each role. You can help consumers understand these different types of representatives so they can make informed choices about who speaks or acts on their behalf.

It is important to enter consumers immigration document information (such as Alien Number (“A-Number” or I-94 Number), if applicable. Some consumers may have an alien number that is exactly 9 digits long, while some individuals have an older Alien number that is only 7 or 8 digits long. An applicant with an Alien number that is 7 or 8 digits should add 1 or 2 zeroes (“0” or “00”) at the beginning so the A-number is 9 digits long. Entering a 9-digit Alien number will prevent an error message and reduce the likelihood that a consumer will experience an immigration status data matching issue and/or will have to submit documents later. Assisters can use this tip to help consumers include their document number on their application. Also, you should encourage applicants to include as much information as possible about their immigration status and household information, which will help increase the likelihood of a successful application submission.

On February 5, 2016 the Centers for Medicare & Medicaid Services (CMS) provided a special enrollment period (SEP) for consumers who:

  • are not currently enrolled in 2016 coverage through the Federally-facilitated Marketplace (FFM),
  • are not receiving advance payments of the premium tax credit (APTC) in 2016 because they failed to file a tax return for 2014 and reconcile their APTC, and
  • subsequently filed their 2014 tax return and reconciled their 2014 APTC.

This SEP will only be available to consumers after they restore their eligibility for APTC by filing a 2014 tax return, reconciling APTC paid on their behalf in 2014, and returning to the Marketplace to attest to having filed and reconciled 2014 APTC.

For more information copy and paste the following link in your browser:  https://www.regtap.info/uploads/library/ENR_FTR_SEP_Guidance_020516_5CR_020516.pdf

This chart below provides a reference on when consumers should contact the Marketplace Call Center or the IRS if they have questions about how their coverage status and/or Marketplace financial assistance will affect the tax filing process. Use this resource in your work with consumers to help route their questions accordingly.

Marketplace HCAN website

As tax season approaches, we’ll be featuring information that you can use when helping consumers understand how their insurance coverage may affect their tax filing process.

Reminder: Taxpayers who enrolled in coverage through the Health Insurance Marketplaces and received advance payments of the premium tax credit (APTC) must reconcile the total APTC they received during the year with the amount of premium tax credit (PTC) for which they are eligible based on their income using a tax statement from their Marketplace called a Form 1095-A. Specifically, consumers should use information from their Form 1095-A to complete Form 8962—Premium Tax Credit.

Recommended Resource: To help consumers better understand how premium tax credits work, we encourage you to check out the video, “How premium tax credits work,” posted on this page of HealthCare.gov. This video, which is also available in Spanish, can help consumers make the connection between receiving APTC throughout the year and reconciling this financial assistance during tax time.

For more tax –related information and tips, see “Taxes & the Health Insurance Marketplace” section on HealthCare.gov, the “Tax information” section on Marketplace.CMS.gov, and the “Affordable Care Act Tax Provisions” section of the IRS website.

Dial 1-877-229-8493 and use the PIN 15035 to join the teleforum.


Syphilis Rates are on the Rise Among Men and Women. Learn What Health Centers and Public Health Can Do Together.

The Centers for Disease Control and Prevention’s 2014 Surveillance Report shows a troubling rise in syphilis infections in both men and women. Health centers can and do play a vital role in routinely testing those at highest risk for syphilis, recognizing signs and symptoms of syphilis infection, and treatment.

This teleforum will feature:

  • a brief overview of the current syphilis epidemic from the health center and CDC perspectives;
  • a call to action for primary care providers and extended care teams;
  • health centers and public health partners describing models and promising practices for engaging patients, utilizing extended care team members, public health resources such as Disease Investigation Services (DIS), and community partnerships to respond to the syphilis epidemic, and
  • significant time for audience members to ask questions of the assembled panelists.

Syphilis Facts

  • Rates of primary and secondary syphilis have increased by 15% since 2013.
  • Rates of congenital syphilis increased by 38% between 2012-2014.
  • Increased syphilis rates are evidence of missed opportunities with the public health and health care systems.

Recommended Audience

Community health center care team members; community health center staff working in partnership with public health and community-based agencies; primary care association clinical quality staff; public health and community-based partners of community health centers.

Contact Information

Dial 1-877-229-8493 and use the PIN 15035 to join the teleforum.