When the Centers for Medicare & Medicaid Services (CMS) sketched out draft rules for the 2017 individual major medical open enrollment period, one section dealt with Web broker entities (WBEs).
CMS, the agency that oversees all Patient Protection and Affordable Care Act (PPACA) public exchanges and runs the HealthCare.gov exchange enrollment for states that choose not to run their own enrollment systems, suggested that HealthCare.gov could simply provide PPACA benefits eligibility determinations for the WBEs, and that the WBEs could handle the rest of the tasks involved with getting people enrolled in public exchange plans.
CMS suggested that the WBEs ought to meet certain exchange plan display and sorting standards, to keep the public exchange system competitive and fair to all the players.
Representatives from two of the more transparent state-based exchanges, Covered California and Connect for Health Colorado, say CMS ought to be paying much more attention to service standards.
Peter Lee, the executive director of Covered California, has told CMS in a comment letter that, if CMS wants to expand the role of WBEs, it needs to develop much tougher rules governing how WBEs display plan information and how well they support consumers.
A WBE should commit to specific staffing service standards; employ well-trained advisors who can help consumers over the phone, in person and online; have the ability to take the documents needed to resolve application inconsistencies via the Web; and, in general, handle most of the customer service work HealthCare.gov or a state-based exchange handles, Lee writes.
“One of the valid rationales for using WBEs is to take the workload and expenses off of the federal or state-based call center,” Lee says. “This value proposition requires the [federally facilitated exchange] to put clear standards in place.”
Alan Schmitz, the general counsel of Connect for Health Colorado, writes in a comment letter that the board of Colorado’s exchange worries CMS might require state-based exchanges to work with out-of-state WBEs.
A requirement to work with WBEs could “significantly undermine the strong broker relationships Connect for Health Colorado has worked to build,” Schmitz writes.
The Colorado exchange has had some conflicts with in-state brokers, but in-state brokers serve as a vital component of exchange enrollment efforts, and “will aid the organization’s long-term sustainability,” Schmitz says. “In-state brokers bolster the local economy, are better suited to developing personal relationships with customers and can provide in-person assistance to customers.”
Web brokers are less likely to develop strong relationships with local customers, Schmitz says. Working out reciprocal licensing relationships with WBEs’ home states could also cause problems since Colorado has state-specific licensing standards, Schmitz says.
If out-of-state WBE representatives have problems with attending in-person events in Colorado, that could also hurt the level of service the WBEs could provide, Schmitz says.
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