Interim Final Exchange Regulations Issued

By Guest Blogger

On Monday, March 12, the Centers for Medicare and Medicaid Services (CMS) released the final exchange regulations. These regulations include the final (and in some instances, interim final) versions of two different regulations that were issued last summer: one on exchange establishment, the functions of an exchange, and enrollment (among other things), and one on eligibility determinations for exchange coverage, premium tax credits, and cost-sharing subsidies.

We’re only just beginning to dig in, but we wanted to flag a few issues of most interest to enrollment stakeholders:

  • The initial open enrollment period for exchanges will be October 1, 2013 to March 31, 2014. This is one month longer than was originally proposed, which means there will be more time to enroll more people.
  • Open enrollment for subsequent years will be October 15 to December 7. Again, this is the longest of the periods that CMS was considering. It is also aligned with the Medicare open enrollment period, which may make public education efforts easier.
  • The rule sets stronger accessibility standards for the exchange website, call center, outreach and enrollment efforts, and other consumer assistance functions. Information has to be provided to people in plain language, and it must be accessible for people with disabilities and people with limited English proficiency. This means that oral interpretation and written translations must be available at no cost to consumers, and exchanges must provide taglines in non-English languages to let consumers know that these services are available.
  • Exchanges will be able to rely on attestations to a greater extent than originally proposed. Exchanges will accept an applicant’s attestation of information (other than citizenship and immigration status) in cases when there is an inconsistency, and information to resolve the inconsistency doesn’t exist or isn’t readily available. This reduces the paperwork burden on consumers, making it easier for them to enroll.
  • More opportunities to comment. Eight discrete sections of the regulation remain open for public comment for 45 days after the regulation is published in the Federal Register (which is scheduled to happen March 27; those who want to comment have about eight weeks to do so). These interim final rules are almost all related to enrollment, and therefore they warrant special attention:

–   155.220(a)(3): On the role of agents and brokers in assisting people with enrollment in an exchange plan

–   155.300(b): On coordination with Medicaid and CHIP regulations

–   155.302: On an option for exchanges to conduct Medicaid and CHIP eligibility “assessments” rather than determinations

–   155.305(g): On eligibility for cost-sharing reductions

–   155.310(e): On timeliness standards for exchange eligibility determinations

–   155.315(g): On accepting attestations in special circumstances

–   155.340(d): On timeliness standards for transferring information about premium tax credits and cost-sharing reductions

–   155.345(a) and §155.345(g): On agreements between exchanges and other agencies administering health coverage programs

There’s much, much more in this regulation (it is 644 pages long, after all), and the parallel Medicaid eligibility regulation will likely be released soon. It will be important to read these two regulations together to get a more complete picture of how enrollment and eligibility should work. We’ll blog again after we have more time to really sink our teeth in. Until then, happy reading!


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