New CMS/ACA requirement for paper or phone recorded attestation of understanding

[yorkriver1]

Now when doing an app the client needs to be recorded agreeing to the app attestation outlined by CMS or has to sign a paper form.
My question is does that apply with existing clients when doing life changes? Like dropping off a spouse when they turn 65.
Kind of a parallel with the decision that agents don't have to record service calls with existing Medicare clients.

 

[Yagents]

If you look at cms sample form, it states the attestation is valid until client revokes. So, u must do current clients at least once, with no expiration date is how I read it. I may plan on getting these forms out to current clients before oep

 

[bluediamond]

If you look at cms sample form, it states the attestation is valid until client revokes. So, u must do current clients at least once, with no expiration date is how I read it. I may plan on getting these forms out to current clients before oep

Just got off a webinar and yes you are correct and I am going to send letters out ASAP.

 

[yorkriver1]

If you look at cms sample form, it states the attestation is valid until client revokes. So, u must do current clients at least once, with no expiration date is how I read it. I may plan on getting these forms out to current clients before oep

The compliance VP at my upline is checking with a law firm with a department specializing in plan compliance.
There is also a required attestation that someone in the client household has reviewed the app for accuracy and understands all the required app check box statements they have to agree to. That is a second challenge. If there is a way to cover all that easily, I would like to know. Will that 2nd part be every time the client's app is updated.
We are sort of in the area now of Scope of Appointment type documentation, which has evolved into software and databases that can record and preserve that data, have apps that offer texting, call recording, etc.
Will carriers or FMO's be able or willing to create systems for that.

 

[bluediamond]

The compliance VP at my upline is checking with a law firm with a department specializing in plan compliance.
There is also a required attestation that someone in the client household has reviewed the app for accuracy and understands all the required app check box statements they have to agree to. That is a second challenge. If there is a way to cover all that easily, I would like to know. Will that 2nd part be every time the client's app is updated.
We are sort of in the area now of Scope of Appointment type documentation, which has evolved into software and databases that can record and preserve that data, have apps that offer texting, call recording, etc.
Will carriers or FMO's be able or willing to create systems for that.

In that webinar today they did mention we'd have to have another form signed at the end of app before the clients signature. But my understanding is that is kept on file by you or upline just in case there are complaints down the road. We can thank all the scammer's that someone get one's name and dob and places themselves as the agent and to stop agents from just going into their own clients and changing anything without the clients consent. We can thank the scamming agents out there for all this.

 

[rmhaire]

There is also a required attestation that someone in the client household has reviewed the app for accuracy and understands all the required app check box statements they have to agree to. That is a second challenge. If there is a way to cover all that easily, I would like to know. Will that 2nd part be every time the client's app is updated.

This has to apply to someone with a guardian, POA or can't speak english. Even CMS can't violate insurance law.

 

[yorkriver1]

Text of notice about app review documentation. I now see some things about signed AOR document. Will update after legal counsel has reviewed. Note: the ruling mentions the consumer's authorized representative. Example: I am set up as an authorized representative for some clients, since occasionally they may be out of the country, a recent example, when the last day a spouse can be on the plan upon turning 65 occurs and they need to be removed from the app the last day of the month. Occasionally, the process requires assistance from the Marketplace, thus auth rep status as a backup. It would be interesting if that form of authorized representative to fulfill the consumer app review would work, since it's being implemented to have agents practices watched over.
Text from explanation document quote: (this doesn't refer to the permission for the broker to work on the app, it's about the consumer reviewing app contents--the second requirement)

"Beginning on June 18th, 2023, CMS will also require agents, brokers, and web-brokers to meet the new requirements under 45 C.F.R. 155.220(j)(2)(ii) to document a consumer or their authorized representative reviewed their application and attested to the information being accurate. CMS does not require all parties on an application review their information and confirm it is accurate or provide consent. While it is a best practice to ensure all parties on an application do these things, it is not a realistic expectation in all scenarios. Therefore, CMS allows either a consumer or a consumer’s authorized representative designated in compliance with § 155.227 to take the action that produces a record that can be maintained by the assisting agent, broker, or web-broker attesting they have reviewed their application information and it is accurate.
The documentation created by the consumer or the consumer’s authorized representative must contain the minimum requirements listed in 155.220(j) to be compliant. 155.220(j)(2)(ii)(A)(1) requires the documentation must include:
• The date the information was reviewed;
• The name of the consumer or their authorized representative;
• An explanation of the attestations at the end of the eligibility application; and
• The name of the assisting agent, broker, or web-broker
This documentation must be maintained for a minimum of 10 years.
The Centers for Medicare & Medicaid (CMS) does not prescribe a standard format or process for obtaining the documentation of consent or application review or for maintaining these records, provided the requirements listed in 45 C.F.R. § 155.220(j)(2) (ii) and (iii) are met.
Additionally, you may obtain consent or confirmation of application review verbally (such as over the phone), electronically (such as via email), or in person. Thus, you have flexibility to determine how you will meet the documentation requirement. While CMS does not require a form, or specify that a form must be signed, you can use the draft model consent form that CMS has developed, available by downloading the ZIP file found at:

https://www.cms.gov/regulations-and-guidance/legislation/paperworkreductionactof1995/pra-
listing/cms-10840

This form is optional, but if it aligns with state law in your state, it may provide a template for meeting the consent documentation requirement. You can also use a Broker of Record (BOR) form from an issuer or state Department of Insurance (DOI) or the applicable state regulatory agency to satisfy this requirement. If you are assisting verbally (such as over the phone), you may obtain consent and confirmation of application review by reading a script that contains, at a minimum, the required
elements summarized above, and must maintain a record demonstrating that the requirements were obtained. As CMS does not prescribe a particular method, any recording method that contains the elements required is acceptable.
For the most up-to-date information on the roles and requirements of agents and brokers in the Marketplace, visit
https://go.cms.gov/CCIIOAB end quote

 

[yorkriver1]

This has to apply to someone with a guardian, POA or can't speak english. Even CMS can't violate insurance law.

You may be mixing that with SOA rules. Someone has to sign an SOA whether it's the consumer or a POA, etc. I don't think the ruling means only if the person has an authorized rep, it's either the person or their rep. See my follow on post with language from the information received about the new rule. I am waiting for word about some clarifications. Looks like we are potentially going to be in the documentation/call recording situation similar to Medicare. The integrated software for that doesn't exist for ACA as I understand it. My state is going to a state based exchange and we won't have the equivalent of HealthSherpa for quote/enroll. I suppose resistance is futile, adapt and in my case be grateful for the opportunities we have. I like your posts, btw.