On September 2, the Centers for Medicare and Medicaid Services released a set of seven updated federal standard health insurance plan renewal and product discontinuation notices. The guidance finalizes draft notices posted in April of this year and updates notices posted in 2014.
Health Insurers in the individual or group market, both inside and outside of an exchange (marketplace), are required under guaranteed renewability rules to give notices to their enrollees when the insurer discontinues or renews a product (including renewals with uniform modifications) or when they non-renew or terminate coverage because an enrollee has moved outside of the product’s service area. Under qualified health plan (QHP) rules, QHP insurers must also give notice to enrollees of renewals, product discontinuances, terminations, and non-renewals, including situations where the insurer reenrolls a QHP enrollee in a different product through the marketplace.
The standard notices have been updated to make them more consumer friendly—shorter, simpler, and easier to understand and navigate—and to help consumers understand what they must do, by when, and where they can get help if they need it. The new notices highlight the individual shared responsibility requirement and encourage consumers to maintain coverage. They explain that advance premium tax credits amounts may change with coverage changes and that in some cases consumers may not learn of their actual monthly premium obligation until they get a bill for the next coverage year.
The notices emphasize the ability of consumers who have been reenrolled to choose a different plan if they want to. They encourage consumers to report life changes to the marketplace and tell consumers how they can get assistance in foreign languages.
Changes Responding To Public Comments
The April 21, 2016 draft notices were revised in several respects in response to public comments. The notices now warn consumers that if they fail to enroll in a marketplace plan during open enrollment they may not be able to do so later, even if their finances change; clarify that estimated premiums for the coming year are based on current information; provide the deadline date for the first premium payment for the coming year, and allow insurers to identify for consumers the consumer’s agent or broker, with contact information, as a source of help for the consumer.
Finally, the notices incorporate two changes that have been made in the reenrollment hierarchy for 2017. First, if an insurer no longer offers a silver qualified health plan (QHP) for renewal in the same product for the next year, the insurer must reenroll an enrollee in a silver level QHP in the most similar product it offers (or if none is available in a QHP in the next higher or lower metal level), although the enrollee may choose to remain with the consumer’s current product.
Second, if an insurer no longer offers any QHPs through the marketplace, an enrollee may be reenrolled in a plan offered by a different insurer (see below). Insurers leaving a marketplace may not automatically reenroll their enrollees in a plan they offer off the marketplace, although they may encourage enrollees to switch to such a plan.
Insurers may use electronic delivery for notices where a consumer has affirmatively agreed to electronic delivery and the insurer meets federal and state requirements for electronic delivery. Insurers that are subject to the section 1557 nondiscrimination regulations or HHS marketplace nondiscrimination requirements must include in their notices language taglines about language assistance availability as required by federal regulations. States that enforce the guaranteed renewability requirement may mandate the use of their own notices as long as the notices are at least as protective as the federal standard notices.
Although notices are supposed to be provided at least 90 days prior to discontinuation of coverage, CMS will continue to allow insurers to send notice for non-grandfathered, non-transitional plans before the first day of the next annual open enrollment period, and for grandfathered and transitional plans 60 days before the day of renewal. When transitional plans are uniformly modified to become ACA compliant, insurers should send a renewal rather than a discontinuation notice.
In a change under the new guidance, insurers that insure student health plans must either provide the required notices directly to student enrollees or ensure that the institution of higher education the student attends does so. It is not enough simply to provide notice to the college or university, as insurers were allowed to do in the past.
Under the proposed 2018 payment rule, CMS will consider a product to be the same product when offered by two insurers under common control if it meets the standards for uniform modification of coverage. If this proposal is finalized, a transfer of a member from one insurer to another under common control would be considered a renewal for purposes of notices.
Insurers automatically reenrolling a consumer must send a summary of benefits and coverage (SBC), appropriate to the individual’s cost-sharing reduction payment level, for the new coverage at least 30 days prior to the first day of the new plan or policy year. The SBC, or other supporting material, can be included in the same mailing as the standard notice.
The new notices must be used for policy years beginning on or after January 1, 2018. Prior to that time insurers may use the new notices, the draft notices published in April, or the 2014 notices.
The Auto-Reenrollment Process
Also on September 2, CMS released a separate set of frequently asked questions containing additional information on the process it intends to use to auto-reenroll consumers in the plans of other insurers when their insurer leaves the marketplace. http://ift.tt/2ce4KjS The guidance explains that the consumer will need to make a binder payment before their enrollment in the “suggested alternative plan” to which they are assigned will become effective. CMS observes that auto-reenrollment is important to keeping younger enrollees in the marketplace—in 2016, the median passive reenrollee was four years younger than the median active enrollee.
In the preface to the 2017 payment notice, CMS explained that the marketplaces would generally seek to reenroll consumers whose insurers left the marketplace in the lowest cost plan offered by another insurer with the same product network type. The guidance, however, notes (as did the 2017 payment notice) that CMS would have flexibility in assigning consumers to plans and that it would consider the financial capacity of plans to absorb additional enrollees and feedback from insurers and state regulators before making assignments. States may also develop their own alternative crosswalks for reassigning plans and may submit these crosswalks to CMS by September 13, 2016.
Civil Money Penalties Inflation Adjustments
HHS also released on September 2 interim final regulations implementing the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015, which amended the Federal Civil Penalties Inflation Adjustment Act of 1990. The 2015 law provided for an initial “catch-up” inflation adjustment to current civil money penalty amounts and annual adjustments thereafter. The new amounts found in the interim final rule apply to civil money penalties imposed after August 1, 2016 for infractions that occurred after November 2, 2015.
The regulations cover dozens of civil money authorities in the Medicare and Medicaid program or other programs administered by HHS. Relevant to the ACA, it sets out increases to the maximum penalty:
- For willfully failing to provide a summary of benefits and coverage as required, from $1000 to $1087 per covered individual;
- For each day and each affected individual for violating regulations related to medical loss ratio reporting and rebating, from $100 to $109;
- For providing false information on an exchange application, from $25,000 to $27,186;
- For knowingly and willfully providing false information on an exchange application, from $250,000 to $271,862; and
- For knowingly and willfully disclosing protected information from an exchange, from $25,000 to $27,186.
IRS Releases ACA-Related Data From 2014 Returns
Finally, the Internal Revenue Service has released a report on Individual Tax Returns for 2014 that contains text relating to 2014 ACA tax filings. During 2014, 3.4 million taxpayers claimed advance premium tax credits of $12 billion; 1.5 tax million taxpayers claimed additional tax credits of $1 billion when they filed their taxes, while 1.8 million taxpayers replayed excess premium tax credits of $1.4 billion. Eight million taxpayers paid $1.7 billion in individual responsibility tax payments while 13.3 million taxpayers claimed an exemption from the tax on their tax form.
The largest number of taxpayers claiming premium tax credits had household incomes in the $15,000 to $25,000 range. The largest numbers of taxpayers paying the individual responsibility payment had household incomes in the $10,000 to $25,000 range, or $50,000 and above.
from Health Affairs BlogHealth Affairs Blog http://ift.tt/2c5UIQv
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