CMS Posts Slides From 2016 Qualified Health Plan Issuer Conference

Implementing Health Reform. The Centers for Medicare and Medicaid Services (CMS) regularly publish at the REGTAP.info website (free registration required) presentation slides from CMS conferences and webinars. For the past several days they have been posting slides from sessions at the 2016 Qualified Health Plan (QHP) issuer conference which was held in Baltimore from March 2 through 4, 2016.

CMS has posted more than 20 slide sets so far, covering the full range of topics covered by the 2017 Letter to Issuers, including network adequacy, changes in the Small Business Health Options (SHOP) program, and machine readability of provider directories and formularies. Many of the presentations are quite technical, describing, for example, the use of the HIOS or SERFF systems or lessons learned from the 2016 Batch Auto Renewal (BAR) process through which 2015 enrollees were auto-reenrolled for 2016.

One set of slides deals with a CMS initiative that has so far received little attention — the maintenance 834 process. The federally facilitated marketplace uses the 834 process to communicate with insurers about enrollments and changes in enrollments. The FFM processes millions of enrollment changes annually.

Currently, when changes occur the FFM must send one transaction cancelling or terminating the initial exchange assigned policy and then a second transaction creating a new exchange assigned policy incorporating the change, even though the policies are in fact a single policy. This process requires CMS to process twice as many policies as are necessary, insurers to have to manually consolidate the separate policies with increased errors, consumers to receive separate 1095A reports for each change, and added casework for CMS.

CMS will soon start using Maintenance 834s (M834s), which should allow the FFM and insurers to handle policy changes with a single automated transaction, maintaining a single policy. Some changes will still trigger a termination and creation of a new policy, such as changes in ID codes, exchange policy start or end dates, or tobacco use codes. But 80 to 90 percent of changes will be handled through the automated M834 process. The change should reduce FFM and insurer workload and consumer confusion. Testing of the M834 process should begin this summer with a hoped for roll out in the fall before open enrollment for 2017 begins.