Health Reform WK-EDGE OTHER AGENCY DOCUMENTS: CMS provides guidance for direct enrollment website compliance
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Tuesday, June 2, 2020

OTHER AGENCY DOCUMENTS: CMS provides guidance for direct enrollment website compliance

By Rebecca Mayo, J.D.

CMS has provided guidance to assist direct enrollment entities in ensuring their websites do not provide any misleading information.

To provide information on how Direct Enrollment (DE) entity websites may avoid noncompliance with standards of conduct, CMS issued a guidance bulletin. DE websites generally provide information to consumers enrolling in qualified health plans (QHPs). They may also provide assistance in applying for financial assistance through the Patient Protection and Affordable Care Act’s Federally-facilitated Exchanges (FFEs) and State-based Exchanges on the Federal Platform (SBE-FPs). However, this information must be correct and must not omit material fact or be misleading. In the newly released bulletin, CMS provided information on what could be considered noncompliant and included illustrative examples of website content to avoid (CCIIO Bulletin, May 22, 2020).

Screening. Most DE websites ask consumers a series of screening questions to assist customers with determining whether they may have had a qualifying life event that makes them eligible for a special enrollment period (SEP) or whether they may qualify for insurance affordability programs. CMS advises that qualifying language should be used in any preliminary determination that a consumer is eligible or ineligible for an SEP or insurance affordability program. For example, consumers should be made aware that they "may" be ineligible rather than that they "are" ineligible and any informational or explanatory text should not imply or state that the screening questions provide an official or final eligibility determination. Information should not imply or state that the qualifying life events asked about are the only possible qualifying life events if the questions fail to ask about all possible qualifying life events.

Disclaimers. CMS recommends the use of qualifying language to clearly communicate that screening tools offered by the DE offer only preliminary information and that an official eligibility determination may only be provided by the Exchange. Additionally, if the initial screening indicates that a consumer may not be eligible for an SEP, the consumer should be provided an explanation that they can still fill out an application to confirm eligibility in case the consumer qualifies for an additional complex situation that the screening tool does not account for.

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