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Life Health > Health Insurance

What the feds are telling health producers now

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The Center for Consumer Information and Insurance Oversight (CCIIO) is continuing to stay out of the battle over health insurance producer compensation.

But CCIIO, the arm of the Centers for Medicare & Medicaid Services (CMS) in charge of overseeing the Patient Protection and Affordable Care Act (PPACA) exchange systems, notes that brick-and-mortar agents and brokers who work with can choose which insurers’ plans to sell.

The Web broker entities (WBE) that register for the ability to connect directly with do have to display all of the qualified health plans (QHPs) available to a consumer, and they do have to help consumers enroll in any available QHP, CCIIO officials say in a new batch of guidance, or informal advice, about the role of agents, brokers and WBEs.

“With the exception of Web brokers, agents and brokers are not required to display all QHPs or to facilitate enrollment into all QHPs,” officials say. 

In California, the District of Columbia and other jurisdictions with locally based exchange programs, the exchange managers can set their own producer standards, officials say.

Both in states and in states with locally based, locally run exchanges, state standards may also affect the kinds of relationships producers have with the QHP issuers, officials say.

CCIIO officials say the QHP issuers and the issuers’ producers are responsible for creating and using any plan compensation agreements.

Officials do not address the issue of mid-year changes in exchange plan producer comp rates.

See also: As Humana jolts market, Kentucky pans mid-year agent comp changes

CCIIO officials say agents and brokers play “a role” in telling consumers about their coverage options, and a “critical role” in support the employers who get coverage through the PPACA Small Business Health Options Program (SHOP).

CCIIO officials have also posted a batch of answers to questions about producers. Officials note, for example, that whether producers can get commission for enrolling people in Medicaid managed care plans is up to a state’s insurance regulators and Medicaid program managers.

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