Healthcare.gov Consent Retention Requirements
Beginning June 18, 2023, the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) are implementing new regulations (CMS-10840) regarding consumer consent. These new regulations center around the two topics found directly below:
1. New consumer consent requirements
Agents are required to obtain and document consumer consent prior to assisting with or facilitating an enrollment for coverage through Federally-Facilitated Exchanges and State-Based Exchanges on the Federal platform or assisting an individual with applying for advance premium tax credit or cost sharing reduction.
This consumer consent requires the consumer or authorized representative to take action to produce a record like providing a signature or recording a verbal confirmation, and it must contain, at a minimum, the following information:
- A description of the scope, purpose, and duration of the consent provided by the consumer or their authorized representative;
- The date the consent was given;
- The name of the consumer or their authorized representative;
- The name of the agent being granted consent; and
- A process through which the consumer or authorized representative may rescind the consent.
2. New eligibility application confirmation requirements
Agents are required to obtain and document that eligibility application information has been reviewed by and confirmed to be accurate by the consumer prior to application submission for coverage through Federally-Facilitated Exchanges and State-Based Exchanges on the Federal platform.
This consumer consent for application accuracy requires the consumer or authorized representative to take action to produce a record (e.g., providing a signature, or recording a verbal confirmation) that must include, at a minimum, the following information:
- The date the application 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 agent providing the assistance.
Important: Documentation for both of these new requirements must be retained for a minimum of 10 years and made available upon request in response to monitoring, audit, and enforcement activities.
These new requirements have been formed under the Patient Protection and Affordable Care Act: HHS Notice of Benefit and Payment Parameters for 2024 and will assist with:
- Resolving consumer complaints related to incorrect information on their eligibility applications or unauthorized enrollments
- Resolving disputes between agents and consumers, or between multiple enrolling entities
It is REQUIRED that all agents and brokers adhere to these new requirements to ensure compliance.
To help you navigate through these new regulations, we’ve prepared the following resources:
Consent Form: This is updated to align with the CMS guidelines and is available in English, Spanish, and Creole.
Agent Scripts: Two comprehensive scripts have been developed to guide you through the process of obtaining written and voice-recorded consent, and to address the required CMS disclosures. These are also available in English, Spanish, and Creole.
Email Template: A straightforward email template to communicate these changes to our clients, highlighting our commitment to compliance.
FAQs: We’ve compiled a list of potential questions that clients may ask, complete with straightforward answers to assist you.
