November 30, 2018


In This Issue
Fast Facts
State Spotlight: CMS Releases Four Concepts for Waivers, Including Reinsurance Programs
CMS Introduces Enhanced Direct Enrollment for Federal Marketplace
IRS Extends ACA Reporting Deadline and Transitional Relief in 2020
NAHU Seeks Balance-Billing Stories to Shape Forthcoming Legislation
Healthcare Happy Hour: How States Can Take Advantage of ACA Waivers
HHS Adjusts Civil Monetary Penalties
Register Now for Next Week’s Webinar on Transitioning to a Fee-Based Business
December’s Compliance Corner Webinar Features a Deep Dive on AHPs
Scholarships Available for Capitol Conference
HUPAC Roundup
What We’re Reading
E-mail the Editor
Visit the NAHU Website
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CMS Introduces Enhanced Direct Enrollment for Federal Marketplace

On Wednesday, CMS announced a new enhanced direct-enrollment pathway for consumers to enroll in health insurance coverage through The streamlined service is an extension of the existing direct enrollment pathway in use since 2013, and allows private sector partners to enroll consumers directly without going through the federal marketplace. Brokers who use this pathway will be able to use the portal to resolve application issues, or update items in a consumer’s application, such as address or name, without having to reenter all of the data in the application. NAHU has long advocated for a broker portal, but due to technology and budgetary constraints, an enhanced direct enrollment is the closest to a “broker portal” available for the federal marketplace.

The enhanced platform streamlines the process that currently redirects consumers to to submit their application and receive an eligibility determination that then redirects to the partner’s website to complete plan selections and enrollment. Under the new fully integrated platform, consumers can apply, enroll, and manage their information through an approved partner website throughout the year. One of the biggest advantages of enhanced direct enrollment is that agents will be able to access their clients’ 1095 forms as well as any other notices that are sent to the enrollee, and consumers will also be able to download Exchange notices, get status updates, or follow up on actions they need to take directly through the partner’s website. This should alleviate many issues with income verification, submitting documents and renewals.

To be certified as an enhanced direct enrollment partner, entities are required to undergo audits to ensure compliance with nearly 300 security and privacy standards, as well as business audits to ensure systems will accurately deliver consumer information that is used to determine consumer eligibility. CMS will be continuously monitoring each partner to ensure they remain in compliance with these requirements.

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