Agent group says they’re ignored by CMS on guidance

Federal officials have answered a batch of navigator questions about the exchange enrollment process — and an agent group is asking why agents have such a hard time getting the same information.

Officials at the Centers for Medicare & Medicaid Services talk about informal problem resolution procedures, the formal appeal process, uninsured penalty hardship exemptions and other topics in the latest issue of the CMS Weekly Assister Newsletter.

CMS sends the newsletter to navigators and certified application counselors.

B. Ronnell Nolan, president of Health Agents for America, says her group e-mailed a copy of the entire newsletter to members because, as far as members can tell, CMS is not making that newsletter or any similar source of information available to the agents certified to help consumers buy private qualified health plan coverage from the federally run health insurance exchanges.

CMS officials suggest in the newsletter, for example, that consumers who are having problems with eligibility determinations or enrollment should start by calling the exchange call center and going through a troubleshooting process.

Consumers who want to make formal appeals can do so either through the "My Account" section on HealthCare.gov or by writing to an office in London, Ky.

A consumer has 30 to 90 days from the date of an eligibility determination to file an appeal, and the consumer can enroll in QHP coverage while waiting for a decision.

CMS is still deciding when either QHP or Medicaid coverage will take effect if and when a consumer wins an appeal, officials say.

The officials also provide many links to CMS consumer information, such as a page explaining the "shared responsibility" penalty hardship exemption application process.

Nolan said in a comment on the CMS answers that getting the information in a newsletter addressed only to navigators and certified application counselors was frustrating. 

"We have been asking for assistance on the following subject matter," Nolan said. "We are blessed [that] there are people who understand we need this information and provide it to me."

Representatives from CMS were not immediately available to talk about how exchange agents can go about getting the assister newsletter or a similar source of information. 

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