CMS announces new confirmation process for special enrollment periods

AHA News Now

The Centers for Medicare & Medicaid Services will implement a new confirmation process in September to ensure that people who enroll in health coverage through HealthCare.gov outside of the traditional enrollment period meet the criteria for special enrollment. To ensure that consumers have access to coverage when they need it, CMS allows some individuals who lose insurance during the year or experience major life changes to enroll using a Special Enrollment Period if the open enrollment period is closed. However, insurers have raised concerns that some people are waiting until they need care to enroll and then inappropriately claiming eligibility for an SEP, destabilizing their risk pool. To combat abuse of SEPs, CMS will implement a new special enrollment confirmation process for consumers seeking to use one of five common SEPs: loss of minimum essential coverage; permanent move; birth; adoption, placement for adoption, placement for foster care or child support or other court order; or marriage. Consumers who claim one of these SEPs will be required to provide documentation verifying their eligibility. CMS invites consumer advocates, insurance companies and other stakeholders to send their comments on the SEP confirmation process to SEP@cms.hhs.gov.

Topic: Access and Coverage
Tags: Coverage, regulation

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