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Feds list exchange plan review standards

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Obama administration officials have talked repeatedly about the need to get healthy young people to sign up for the new private exchange plans.

But plan issuers that act on that message by discriminating against older consumers or consumers with disabilities could get into trouble with compliance review teams, according to a new batch of QHP compliance review guidance, from the Centers for Medicare and Medicaid Services.

Officials say the new guidance show plan issuers what the feds’ priorities are.

“It is not intended to be an all-inclusive list,” officials say.

The list does not put any limits on the ability of CMS to review compliance with standards left out of the list, officials say.

Officials put notes about health- and disability-related discrimination in the participation standards, plan design and plan notice sections.

In addition to saying that a plan issuer cannot discriminate based on factors such as race, color, disability and age, officials say the issuer cannot employ “market practices or benefit designs that will have the effect of discouraging enrollment of individuals with significant health needs.”

The issuer also must ensure that “delegated and downstream entities,” such as producers, don’t discourage enrollment of individuals with “significant health needs.”

Plan documents must be accessible to people with disabilities. 

Elsewhere in the guidance, CMS officials say a plani issuer should:

  • Submit justifications of rate increases to the exchange before implementing increases and prominently post justifications of the increases on its own website.
  • Verify agents and brokers have met exchange registration and training standards, and signed any necessary agreements, such as privacy and security agreements.

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