Important Changes for Marketplace Agents in the 2024 Final Rule
The 2024 Marketplace Final Rule brings significant changes affecting Marketplace agents. Agents must document consumer consent and confirmation of application details. Also, a longer HHS review period for agent rebuttals is introduced. Navigators and other assisters now have the option to enroll consumers in person. Stay informed to ensure compliance and provide effective assistance to ACA clients.
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CMS ACA Final Rule 2024 Best Practices and FAQ s
2024 Marketplace Final Rule Changes Agents Should Know You canread the full 2024 marketplace final rule here. Most of these changes go into effect for the 2024 plan year (PY2024), but some have other specified implementation dates. The Department of Health & Human Services (HHS) Notice of Benefit and Payment Parameters for 2024 final rule finalizes standards for issuers, marketplaces, agents, brokers, web-brokers, and assisters (navigators, non-navigator assistance personnel, and Certified Application Counselors). Included are changes that will affect your Affordable Care Act (ACA) clients plan choices, coverage, coverage effective dates, and SEP availability. There are also two important changes related to items agents selling marketplace plans will need to document moving forward.
Agent Documentation of Consent from Consumers Note: This Consent is Required Prior to Providing Consumers Assistance Changes That Will Affect Marketplace Agents CMS has finalized an HHS requirement that agents must be able to provide proof they ve received consent from a consumer, or their authorized representative, to help them with their ACA coverage decisions. Agents must retain this documentation for a minimum of 10 years and produce it upon request. While there s no official form to document this consent, AHIA s Compliance team has created a form that satisfies CMS requirement. Click here This consumer consent requires the consumer or authorized representative to take action to produce a record like providing a signature or recording a verbal action to produce a record like providing a signature or recording a verbal confirmation, and it must contain, at a minimum, the following information: A description of the scope, purpose, and duration of the consent provided by the consumer or their authorized representative. The date the consent was given. The name of the consumer or their authorized representative. The name of the agent being granted consent A process through which the consumer or authorized representative may rescind the consent.
Agent Documentation of Consumer Review of Application Consumer Must Confirm All Info Is Accurate Before Application Submission Agents must also document that the consumer, or authorized representative, has reviewed and confirmed all eligibility application information prior to applying. Like the consent documentation, agents must retain this documentation for a minimum of 10 years and produce it upon request. Currently, there s no official form to document this consent.
Longer HHS Review Period for Agent Rebuttals For Suspensions or Terminations of Marketplace Agreements CMS has granted HHS 15 more days, 45 calendar days total, to review agent-submitted evidence to rebut allegations that resulted in the suspension of their marketplace agreement(s) and inform the agent of their decision. HHS will have 30 more days, 60 calendar days total, to review termination reconsiderations and inform agents of their decisions. Navigators & Other Assisters Can Enroll Door-to-Door Includes Upon First Contact Assisters (navigators, non-navigator assistance personnel, and Certified Application Counselors) can conduct door-to- door enrollment assistance. (Agents can too, unless there s specific guidance from their state s Department of Insurance stating otherwise.)
Q. How can we get the consent form doc that CMS released? Frequently Asked Questions A. The sample form that CMS has put out can be found online here. Or you can access AHIA s Consent form by clicking here. Q. Can the consent be verbal and filled out on the form by the agent or must the form be emailed to the client and received before the enrollment can be completed? A. The consent can only be verbal if the call is being recorded. Other than that, the consent would need to be collected either electronically or paper. Q. Are current consents on file still valid? A. If the current consent that you have collected meets the minimum requirement, it would continue to be valid. Q. Will you need to get consent every year? A. We have not seen any specific guidance on this yet.
Q. Do you send the forms in with the application or just store it for your records? Frequently Asked Questions A. These forms would need to be collected and stored where you can access them for 10 years. Q. Am I correct that when it is in the quoting stage, we do not need this form to be completed? A. If the quote is completed generically, you would not need to get consent prior to the quote. You must collect the consent prior to searching the Marketplace or accessing the client s account. Q. Where can I read CMS Final Rule? A. You can read CMS CFR Final Rule by clicking here. Q. What if a client does NOT qualify for a subsidy? Do we still need the Consent Form? A. Yes. You must collect the Consent Form and Eligibility form regardless of Eligibility status.
