This week, NAHU submitted comments on the 2017 Letter to Issuers. Our comments addressed a range of issues, including: providing lead-time for brokers on premium rate releases; delaying the network adequacy standards to allow for the adoption of a recent NAIC model law on network adequacy to be considered by states; broker misconduct review; transmission of broker identification numbers; re-enrollment issues; broker training; and call-center operations. We also took the opportunity to address the increasing prevalence of insurers reducing or eliminating broker commissions during the plan year. We specifically requested that the Centers for Medicare and Medicaid Services (CMS) require that all issuers who file a premium rate that includes broker compensation not to alter the general compensation during the plan year. We are very concerned about insurers who are implementing mid-year compensation changes and the impact that this will have on consumers and market stability, and believe that CMS has the authority to enforce commission rates that were included in plans certified on the marketplace.
Specifically, our comments address the issue by stating:
If an issuer provides brokers with one commission rate during open enrollment then reduces rates for the remainder of the plan year during the special enrollment period, an individual’s access to coverage and exposure to all channels of consumer assistance will be diminished. This is especially true of a commission change that impacts the special enrollment period (SEP), since consumers with SEP rights often need the most help taking advantage of their special status. Furthermore, by reducing their rate to a noncompetitive level midway through the plan year, an issuer may be able to inappropriately shift risk to other issuers in the marketplace causing instability for all. If an issuer reduces its commission rate to zero after the open enrollment process ends, then the issuer can unfairly shift almost all of its potential SEP risk, and certainly all broker-driven risk, to other issuers. If a broker is not being paid for his or her services, then no client relationship is established with the consumer and the broker’s errors and omissions insurance coverage (which protects both the consumer and the broker) does not apply to the relationship and real or potential transaction, thereby making broker support and service on a newly non-commissioned policy impossible.
NAHU also believes that CMS has the responsibility and authority under its rate review and qualified health plan certification processes to ensure that issuers maintain the services that they promise via filed and approved rates throughout the plan year. Much like CMS stipulates that issuers may not change and reduce their initially specified service areas mid-plan year, we believe it would be appropriate for you to stipulate that the services promised as part of approved rates, including access to the purchasing services and plan year, and renewal consumer support offered by a licensed health insurance agent or broker, not be eliminated partway through a given plan year. Otherwise, consumer services that are promised as part of the approved rates of the policy may be reduced, and the consumer would see no corresponding premium reduction.
Our comment letter also addressed several other issues:
- Plan rate timeline: We requested that plan designs and rates to certified agent and brokers and other applicable assisters be included in the official timetable, and that the timetable allow for at least two weeks of review prior to the start of the 2017 open enrollment season.
- Network Adequacy: We requested that CMS postpone any additional actions on network adequacy standards at this time beyond what was already in place in 2016 for the approval of qualified health plans, given the newly released NAIC model law so that states have an opportunity to respond accordingly. We also expressed concerns about how some of the proposed limits on tiered networks could limit the development of cost-saving and quality-enhancing health insurance products that utilize value-based design principles, including tiered networks.
- Broker Misconduct Investigations: We requested clarification about the proposed 90-day timeframe and requirements by the Department of Health and Human Services (HHS) for broker due process, as this is roughly the length of the entire open enrollment period, and if a broker was in fact innocent of wrongdoing, he or she could be shut out of helping consumers altogether for the season if the case was not resolved quickly. We recommend that marketplaces use existing state processes for investigating broker misconduct.
- Dropped NPNs: Given issues of broker identifying information occasionally not transmitting on 834 files, we requested that CMS allow for multiple assister numbers to be including on the marketplace application, which will also add another layer of consumer protection.
- Broker Training: We requested that vendors such as NAHU be able to provide tier-two support to brokers who are having trouble navigating the CMS Enterprise Portal.
- Standards of Conduct: We requested that the final issuer letter acknowledge that there are entities that have used the words “exchange” and “marketplace” in their name prior to the creation of the federal marketplace, and that these entities are in no way deliberately misleading consumers.
- SHOP Renewal Notices: We suggested that the FF-SHOP coordinate the timing of their renewal notices to ensure that the group has met the issuer’s participation and certification requirements before they receive renewal information from the FF-SHOP.
- Broker Support: We requested that the FFM continue to develop a specific means for providing certified agents with more client support as well as a method for them to track problem cases and their resolution for their clients.
Once CMS has had a chance to review all comments the agency will release a final Letter to Issuers for 2017, and NAHU will provide you with any updates in the final letter to our above listed concerns.