CFAHU Legislative Report
submitted by Don Marx, Legislative Chair
How can Agents Enroll Clients in the FFM?
So while healthcare.gov continues to experience technical difficulties, many agents are wondering what the best options are to help clients beyond checking back in later to see if the website ever starts functioning properly. President Obama has touted the call center, but in a best case scenario, at this point the call center can really only help a consumer make their initial application for subsidy determinations. Once the subsidy determination is processed, which can take several weeks, the consumer (and their agent) will then need to call back and start the plan selection process and then enrollment and payment must be processed by the issuer. This is a clunky option at best and it has been further hindered by call center representatives who do not always record the agent’s involvement despite CMS instructions for them to do so (If you are having trouble, try asking for a supervisor). It’s very important that the agent NPN gets recorded for payment and consumer protection purposes up front, so do your best to ensure that it gets recorded. We are working on a fix for if it has not been recorded with CMS, but that may be weeks away, so keep good records.
Another option is a paper application, which given the issues concerning the recording of the NPN, might be your best option since the agent can fill in the numbers for their client. The paper application doesn’t yield an immediate subsidy determination either, but the contractor handling the applications just got an influx of more money to speed up processing and seems to be relatively on the ball. Once your client gets the subsidy determination back, then you can proceed to enrolling in coverage.
The final option is one that has been hindered by healthcare.gov’s technical woes. But we are pressing for immediate priority to be given to addressing the ability of web-based entities and issuers to connect with the federal system to offer consumers additional paths to enroll in exchange-based coverage. Both of these options have been delayed by federal marketplace difficulties, but if they could become functional quickly it would help take the pressure off the federal website and give agents and brokers a much more efficient means of enrolling and servicing their clients. Agents who knew which plan their client wanted could access the carrier directly and those who wanted to help with shopping via their own websites could partner with or subscribe to one of the companies developing web-based enrollment mechanisms. Fingers crossed that these options can get off the ground in time!
Components of Healthcare.gov are working perfectly
On Thursday, October 24, the House Energy and Commerce Committee held what we are sure will be the first of many congressional oversight hearings on the abysmal rollout of healthcare.gov. One thing we learned from the four and a half hour hearing was that according to the contractors that built the system, all the components of healthcare.gov work perfectly, just not perfectly together.
Rather than owning up to any mistakes, the contractors pointed the finger at CMS and insisted their individual products were working. Much of the hearing was spent with representatives from each company repeatedly stating that they worked under the direction of their client, CMS, so any questions regarding the testing process and whether or not anyone was aware of the program flaws prior to open enrollment should be directed to the federal government.
We are getting there or are we?
We recently heard from the president, no one is more frustrated than he is with the problems plaguing healthcare.gov. As a result, he’s promised a “tech surge” to speed up the mending process. We also heard during the House Energy and Commerce Committee hearing that the contractors responsible for healthcare.gov are working to improve their components of the website every day and while there is still much to be done, the website has come a long way. This, of course, was all admitted after the contractors originally claimed that they created a flawless product.
In an attempt to keep the public informed on the “tech surge,” CMS has pledged to hold daily briefing calls to report on the healthcare.gov’s technology progress. Secretary Sebelius has also committed to regular blog posts on healthcare.gov.
As if they didn’t have enough to do with getting the website right
You would think that fixing healthcare.gov would be keeping the fine folks at HHS so busy that they wouldn’t have time to issue new regulations, but, unfortunately, conventional wisdom doesn’t seem to apply when it comes to health reform implementation. HHS released a final rule yesterday on exchange financial integrity and oversight. We are still looking through the 236 pages, but it appears to cover the financial oversight of exchange-based plans and the final details of the law’s reinsurance and risk adjustment mechanisms. It also covers special enrollment periods and makes some changes to market reform definitions. Two of our favorite parts include the provisions governing enrollment satisfaction surveys and the numerous references to more rule-making to come on a wide variety of other PPACA issues.
CMS also quietly released $146.1 million more exchange grant money to the states this week. Four states and the District of Columbia received grants of between $10 and $48 million. The primary purpose of the money is for technology enhancements. No joke intended!
