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June 17, 2013 at 10:00 AM
The “qualified health plans” (QHPs) that sell coverage through the new Patient Protection and Affordable Care Act (PPACA) “federally facilitated exchanges” (FFEs) may have to take money orders, debit orders and cashier’s checks as well as credit cards.
FFE brokers who want to escape from the FFE broker program might have to give their FFEs at least 30 days’ notice.
And, if a QHP fails to provide the information that the FEE managers need to formal risk adjustment programs, then the FFE managers might impose a “default risk adjustment” charge.
In some documents, state and federal exchange builders seem to assume that the time of a health insurance agent or broker who is helping consumers enroll in the exchange QHPs has a low value, but, for purposes of analyzing the economic impact of exchange paperwork requirements, federal officials are assuming that the time of an agent or broker is worth an average of $41.15 per hour, and that the time of a brokerage clerk is worth about $28.81 per hour.
The Centers for Medicare & Medicaid Services (CMS) has included those thoughts, and more, in a new set of draft regulations Patient Protection and Affordable Care Act; Program Integrity: Exchange, SHOP, Premium Stabilization Programs, and Market Standards (CMS-9957-P) (RIN 0938-AR82).
The proposed regulations are supposed to appear in the Federal Register Wednesday.
Comments will be due 30 days after the official publication date.
CMS developed the regulations to fill in gaps in the implementation of many different PPACA provisions that relate to the new exchanges, or health insurance supermarkets, and to standards for individual and small group health insurance.
PPACA is supposed to require insurers in the individual and small group markets to sell coverage on a guaranteed-issue basis, and without taking personal health information other than age and some wellness program information into account when setting prices.
To compensate for the possibility that the new underwriting restrictions could flood some health insurers with costly new patients, PPACA drafters created risk corridor, risk adjustment and reinsurance that are, in effect, supposed to transfer cash from carriers with unusually healthy enrollees to carriers with unusually sick enrollees.
