Filed Under:Health Insurance, Individual Health

CMS posts exchange producer registration drafts

Want to help market an online health insurance supermarket? (CDC photo)
Want to help market an online health insurance supermarket? (CDC photo)

The managers of the new federal Patient Protection and Affordable Care Act (PPACA) exchanges hope to start registering agents and brokers around July 1.

The federal exchange managers want to promote the agents by publishing lists of individual exchange producers starting in August and lists of the producers registered to sell Small Business Health Options Program (SHOP) exchange coverage starting in September.

The Patient Protection and Affordable Care Act of 2010 (PPACA) calls for the U.S. Department of Health and Human Services (HHS) and state agencies to set up Health Insurance Exchange (HIX) program markets, or Web-based health insurance supermarkets, for individuals and small groups by Oct. 1.

The Centers for Medicare & Medicaid Services (CMS), an arm of HHS, has given the information about the federal exchange producer registration process in a batch of exchange producer registration documents posted in the Paperwork Reduction Act area of the CMS website.

The federal Paperwork Reducation Act requires CMS to get public comments when it adds new paperwork, including PPACA paperwork.

CMS has posted batches of documents related to a number of other major PPACA projects, such as efforts to set PPACA "minimum essential coverage" standards, in the same directory. 

The CMS federal exchange registration process would affect only producers who want to work with the "Federally Facilitated Exchanges" (FFEs) that CMS runs, or to exchanges that CMS helps run, not to state-run exchanges.

The HIX producer registration folder includes one rough description of the producer registration form, a rough description of the producer training course, and a discussion of the proposed information collection efforts.

CMS officials have not yet started registering producers.

Appendix A, the shortest document in the CMS-10464 document batch, includes a 1-page description of the information that the exchange producer registration form might seek.

The form would ask for a producer's name, date of birth, office contact information, company name, national producer number, and whether the producer wants to sell coverage to individuals, small groups or both.

The form could contain an optional form seeking a registrant's home mailing address and fax number.

A producer could verify the form with an electronic signature.

Another document in the CMS-10464 batch, Appendix B, describes the elements that might be in the exchange producer training program.

The training program could take about 51 minutes, and it could include modules on topics such as allowable premium variations, eligibility and enrollment, eligibility for Medicaid, and privacy issues.

The appendex gives the following sample question:

Eligibility and Enrollment

A 66-year old woman with an income equal to 200% of the poverty level meets with you. She also has $25,000 in assets in the bank. She wants to know if she is eligible for any premium or cost-sharing assistance:

  1. No, because her income is too high
  2. No, because her assets are too high.
  3. She might be, but it depends on which level of coverage she selects (bronze, silver, gold, or platinum).
  4. No because she is over the maximum age requirement.

CMS is hoping 254,095 health insurance agents and brokers will sign up to work with the new health insurance exchange (HIX) system.

Producers can set up their own enrollment Web sites, but they must apply their exchange training to the development of those sites, officials say in a document explaining the registration form outline and the outline of the producer training course.

"Agent/brokers must sign an agreement that documents their commitment to the FFE requirements, their willingness to periodically update the information collected at their initial enrollment, and their recognition that for the purposes of compliance monitoring they may be asked to make their records available to the FFE when required," officials say.

CMS officials expect many of the producers registering to be small businesses, officials say. 

"The streamlined data collection and training approach employed in this process was tailored to meet their needs and to minimize burden to this group," officials say.

CMS expects to have FFE producers update their registrations annually, to make sure the producers get regular compliance and market information updates, officials say.

Officials are estimating the time spent on the registration process will cost producers an average of about $153 each per year.

CMS is estimating that there may be about 600,000 to 700,000 active U.S. health insurance producers, and that 409,500 live in FFE states, rather than states that will have state-based exchanges.

About 27 percent of the health producers sell products from only one company.

If 85 percent of the remaining, multi-carrier producers go through the producer registration process, the federal exchanges could end up registering 254,095 producers, officials said.

CMS will probably hire a full-time employee who will earn $89,033 per year to oversee the system, officials said.

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