June 19, 2023

The 2024 Notice of Benefit and Payment Parameters (NBPP) outlined additional requirements agents and brokers must take when assisting consumers. During the 2023 Agent and Broker Summit, the Centers for Medicare and Medicaid Services (CMS) announced these requirements would go into effect on June 18.

• Agents and brokers must obtain consent prior to assisting each consumer.
• Agents and brokers must document that eligibility application information has been reviewed and confirmed to be accurate prior to submission.

Documentation Requirements:

CMS did not establish a specific format or means by which this information is required to be received; instead, they established minimum guidelines for both consent and eligibility application review.

• Consent documentation 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, broker, web-broker or agency being granted consent
  • A process through which the consumer or their authorized representative may rescind the consent
• Review documentation must contain, at a minimum, the following information: 
  • 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
  • The name of the assisting agent, broker or web-broker
• Agents and brokers must maintain the documentation for a minimum of 10 years.
• Select this link to download the CMS Model Agent Broker Consent Form.

 
Compliant Business Practices:

Agents and brokers must ensure compliance with Marketplace regulations and guidance when establishing business relationships (e.g., for purposes of lead generation).

• Enrollment assistance must be provided by licensed and registered agents and brokers.
• Agents and brokers are required to obtain consent from the consumer or their authorized representative. Third-party means, such as lead generators, do not constitute consent in a manner that complies with 45 C.F.R. §155.220.  
  • For example, consumers merely checking a box to indicate that they attest to being enrolled in Marketplace coverage does not constitute consumer consent for purposes of complying with CMS Marketplace requirements.
     

Please contact your sales representative for more information.