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CMS posts 2017 PPACA World rules

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The Centers for Medicare & Medicaid Services (CMS) has posted many of the documents health insurers need to design public exchange plans for 2017, as the insurers are trying to finish their 2017 plan applications.

CMS, an arm of the U.S. Department of Health and Human Services (HHS), has released the final version of the letter to carriers that want to sell qualified health plans (QHPs) or dental plans through the HHS HealthCare.gov exchange enrollment system for the 2017 open enrollment period.

CMS also has released guidance on how insurers should go about winding down the “transitional plans,” or “grandmothered plans,” that were put in place after the Patient Protection and Affordable Care Act of 2010 (PPACA) became law and Jan. 1, 2014, and a final regulation that sets many parameters for how PPACA rules and programs will operate in 2017.

Officials say, for example, that they now intend for the open enrollment period to run from Nov. 1 through Jan. 31 in 2017 and 2018, and then to run from Nov. 1 through Dec. 15 every year after that.

Originally, transitional policies were supposed to die with plan years beginning on or after Oct. 1, 2016, or, until Sept. 30, 2017, at the latest. Now, the policies can stay in force until Dec. 31, 2017.

In a draft of the PPACA parameters regulations, CMS proposed strict new disciplinary rules for agents and brokers who sell HealthCare.gov plans. 

CMS proposed a suspension process that might shut out an exchange producer for 90 days, or for the entire open enrollment period, possibly without giving the producer a chance to respond or requiring HealthCare.gov to notify the insurance regulators in a producer’s state about the allegations.

In the preamble to the final version, officials say they have changed the rules to allow HealthCare.gov to terminate producers without 30 days of advance notice, only “where there is a finding … that an agent or broker has engaged in fraud, or abusive conduct that may result in imminent or ongoing consumer harm.”

CMS responded to complaints about possible lack of due process for agents by saying that, in most cases, producers with get 30 days’ notice and an opportunity to respond prior to termination. If a producer submits evidence during the suspension period, HHS will review it and make a determination whether to lift a suspension within 30 days of getting the evidence, officials say.

See also: 

PPACA World 2017: How it’s supposed to work

CMS hates some agents and other draft 2017 PPACA parameters

 

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