Episode Summary
The Centers for Medicare and Medicaid Services (CMS) has introduced new regulations for ACA agents and brokers through the latest Notice of Benefit and Payment Parameters (NBPP) guidance for 2024. This represents the most significant regulatory update impacting the ACA marketplace in years. Agents who understand and prepare for these changes will be well-positioned for the future.
The overarching focus of the new NBPP rules is to provide greater consumer protections and address complaints around unauthorized switching of an enrollee's agent of record. To accomplish this, a major change is that agents will now need to collect written consumer consent before assisting anyone with an ACA plan that involves advanced premium tax credits or cost-sharing reductions.
Specifically, consent forms must be obtained and retained for 10 years. They must include details like the scope and duration of consent, the process for rescinding consent, the names of the consumer and agent, and the date consent was given. CMS has provided a model consent form that serves as a starting point for compliance.
This parallels the long-standing scope of appointment process in Medicare Advantage. However, specifics around approved collection methods for ACA consent are still emerging. For now, utilizing the CMS model form, whether digitally or on paper, is the safest approach until additional guidance comes forth.
The consent requirements kick in on June 18, 2022, for 2023 coverage years. However, CMS advises agents to voluntarily adopt compliant practices immediately to avoid disruptions.
In addition to consent forms, the NBPP focuses on several other key areas:
- Stricter network adequacy enforcement to ensure sufficient provider access
- Plan offering simplification to cut down on excessive and confusing plan choices
- Emphasis on collecting accurate client data to resolve issues like missing Social Security numbers
- Special enrollment guidance around scenarios like Medicaid redetermination
The NBPP notes that active plan options will be reduced by around 20% starting in 2024. Agents should analyze their books now to prepare for potential plan consolidations.
This sweeping NBPP guidance brings monumental change for ACA agents and brokers. Those who take the time to understand the new regulations, and proactively update their processes and data collection, will be poised for success. Compliance and ethical business practices are crucial for maintaining client relationships and books of business in the years ahead.
Timestamps
(0:00:00) - Broker Link podcast features new regulations coming to the ACA in 2024
(0:00:42) - Mike Smith: Notice of benefits and payment parameters from CMS regarding healthcare plans
(0:08:19) - Agents are now required to obtain and document consumer consent before assisting consumers
(0:19:16) - Mike: I want to thank our marketing partners for their efforts
(0:20:01) - How do you get started with The Brokerage Inc.?
