ACA compliance updates
On July 19, 2024, the Centers for Medicare & Medicaid Services (CMS) made updates to Federally-Facilitated Marketplace (FFM) systems to block an agent or broker from making changes to a consumer’s FFM enrollment unless the agent is already associated with the consumer’s enrollment.
New requirements for brokers
An agent or broker who is not already associated with a consumer’s enrollment and who has consent from a consumer to update their Marketplace enrollment will be required to:
- Conduct a three-way call with the consumer and the Marketplace Call Center OR
- Use HealthSherpa’s new Resume Link process
The Resume Link process includes an ID-proofing step designed to protect consumer intent while making application updates. By using this workflow, agents may be able to bypass the need for a three-way call with the Marketplace Call Center. Learn more about CMS System Changes.
This re-enrollment will include the new agent’s NPN and will cancel and replace the auto re-enrollment. To avoid potentially needing to do consecutive three-way calls with a consumer and the Marketplace Call Center, it is recommended that agents and brokers complete all necessary changes to the consumer’s enrollment at once, rather than attempting to make enrollment changes in a piecemeal fashion.
Document consumer consent
Agents must document consent and maintain the documentation for a minimum of 10 years. The documentation must include:
- Description of the scope, purpose, and duration of the consent provided by the consumer or their authorized representative;
- Date the consent was given;
- Name of the consumer or their authorized representative;
- Name of the assisting agent, broker, or web broker; and
- Process through which the consumer or their authorized representative may rescind the consent.
Blue KC will review a random sampling of ACA applications to ensure the consent form has been collected and includes the information above. You may be asked to provide a copy of the consent form.
