CMS recently released the Department of Health & Human Services Notice of Benefit and Payment Parameters for 2017 Final Rule (Payment Notice)

CMS recently released the Department of Health & Human Services Notice of Benefit and Payment Parameters for 2017 Final Rule (Payment Notice) and the Final 2017 Letter to Issuers in the Federally-facilitated Marketplaces (FFMs) (Letter to Issuers), which set forth standards for the FFMs, issuers, and other stakeholders (including agents and brokers) for plan years beginning on or after January 1, 2017.

 

Of particular relevance to agents and brokers, the Payment Notice addresses the following issues:

• Standards of conduct for agents and brokers assisting FFM consumers
• Enforcement policies where there have been allegations of fraud or abusive conduct that may cause imminent or ongoing consumer harm
• Penalties other than termination of an agent’s or broker’s FFM Agreement(s)
• Establishment of a framework to support the use of an expanded Direct Enrollment Pathway option to facilitate enrollment in the FFMs, including the FFM states where the state performs plan management functions (State Partnership Marketplaces [SPMs]) and State-based Marketplaces (SBMs) that use the Federal Platform (SBM-FPs) for web-brokers and qualified health plan issuers in plan year 2018 and future coverage years.

 

Chapter 5 of the Letter to Issuers has information about agents and brokers (section 4), and marketing (section 5), including the following topics:

• FFM registration
• Agent and broker compensation
• Marketing standards

 

CMS encourages you to review both the Payment Notice and the Letter to Issuers to familiarize yourself with these and other requirements for plan years beginning in 2017.