America's Benefit Specialist November 2023

HOW AGENTS AND BROKERS CAN PROTECT THEMSELVES AND THEIR CLIENTS

AGENTS AND BROKERS MAY DOCUMENT CONSUMER CONSENT AND MARKETPLACE ELIGIBILITY APPLICATION REVIEW IN ANY MANNER THAT BEST WORKS FOR THEM, AS LONG AS THEIR DOCUMENTATION MEETS ALL REGULATORY REQUIREMENTS.

agent or broker, and recorded phone conversations between the consumer and approved agent or broker. However, to ensure consumers understand the consent process and can ask questions, CMS does not recommend website-based forms alone or other methods that do not involve directly engaging with the consumer. CMS created a model consumer consent form 2 that Market place-registered agents and brokers can use to comply with the new consumer consent requirement. This optional model consent form is meant to act as a template that agents and brokers can use as provided or adapt for their use and busi ness practices. States may have additional requirements that are not addressed in this optional model consent form, and agents and brokers interested in using or adapting this form should confirm with their relevant state agencies that this form would also meet state requirements. CMS does not have a model form to document the eligibility application review requirements. Ultimately, these regulations give CMS greater authority to terminate any agent’s or broker’s registration with the Market place who cannot provide documentation that a consumer or consumer’s authorized representative gave the agent or broker permission to act on their behalf in connection with enrollment in Marketplace coverage or submission of an appli cation for APTC or CSRs. When making compliance determi nations related to consumer consent, CMS will confirm if the consent was given before an agent or broker assisted with or facilitated enrollment in Marketplace coverage. This includes conducting person searches on an approved direct enrollment (DE) platform. In addition to reviewing the documentation showing that the consumer or an authorized representative consented to the agent or broker assisting the consumer with enrolling in Marketplace coverage or applying for APTC or CSRs, CMS will determine if agent- or broker-initiated application or plan changes are consistent with the documented consent for that initial enrollment. CMS will make this determination when any changes are made to a consumer’s application such as changes in issuer or plan selections, dependents,

contact information, income information or other application fields. If agents and brokers have concerns that another agent or broker has engaged in potential non-compliance, including fraud or abusive conduct, they can contact the Agent/Broker Email Help Desk at FFMProducer-AssisterHelpDesk@cms.hhs. gov. Additionally, agents and brokers can also send operational and policy questions to this help desk. In the 2024 Payment Notice: CMS finalized regulatory up dates requiring agents, brokers and web-brokers to: • document that the consumer or an authorized representa tive consented to the agent or broker assisting them with Marketplace enrollment or applying for APTC or CSRs prior to that assistance being provided. • document that eligibility application information has been reviewed by and confirmed to be accurate by the consumer or their authorized representative prior to application sub mission. CONSUMER CONSENT The documentation must contain, at a minimum, the follow ing information: • a description of the scope, purpose, and duration of the consent provided by the consumer or their authorized rep resentative • the date the consent was given • the name of the consumer or their authorized representative • the name of the agent, broker, web-broker or agency being granted consent • a process through which the consumer or their authorized representative may rescind the consent ELIGIBILITY APPLICATION INFORMATION REVIEW The documentation must contain, at a minimum, the follow ing information: • the date the information was reviewed

4 ABS | benefitspecialistmagazine.com