COVERED CALIFORNIA POLICY AND ACTION ITEMS November 17, 2016 Board Meeting

Transcription

1 COVERED CALIFORNIA POLICY AND ACTION ITEMS Nvember 17, 2016 Bard Meeting

2 INDIVIDUAL ELIGIBILITY AND ENROLLMENT REGULATIONS EMERGENCY READOPTION Bahara Hsseini, Legal 1

3 INDIVIDUAL ELIGIBILITY AND ENROLLMENT REGULATION PROPOSED CHANGES Mdifying the language pertaining t verificatin f family size and husehld incme. Adding new language regarding the Exchange requesting MAGI-based incme data fr all individuals that are cunted in a tax filer s husehld incme. Adding new language regarding verificatin prcedures fr an applicant s attestatin f prjected husehld incme. Mdifying language regarding an applicant s husehld incme being within the Medi-Cal r CHIP MAGI-based incme standard and remving inapplicable language pertaining t reasnable cmpatibility. 2

4 INDIVIDUAL ELIGIBILITY AND ENROLLMENT REGULATION PROPOSED CHANGES Changing the annual incme threshld frm 10% t 25% and incrprating verificatin prcedures within the same sectin. Updating the Reasnable Opprtunity Perid t refer t a 95-day perid. Updating language regarding ineligibility fr APTC r CSR if the cnsumer (1) fails t respnd t a 95-day Reasnable Opprtunity Perid r (2) if the data indicates the cnsumer is eligible fr full-scpe Medi-Cal r CHIP. 3

5 INDIVIDUAL ELIGIBILITY AND ENROLLMENT REGULATION PROPOSED CHANGES Revising the language regarding qualified individuals gaining and lsing dependents and clarifying that lss f a dependent r status as a dependent qualifying life event nly applies t current enrllees. Remving language that allws QHP issuers t determine terminatin dates. Remving language pertaining t effective terminatin dates fr enrllees newly eligible fr restricted Medi-Cal cverage f pregnancy-related services and adding full-scpe when referring t Medi-Cal r CHIP. Adding new language that grants an appellant eligibility pending appeal (cntinued enrllment) fr an appeal f an errneus terminatin f enrllment. 4

6 ENROLLMENT ASSISTANCE REGULATIONS Drew Kyler, Branch Chief, Outreach and Sales Divisin 5

7 REGULATIONS In Octber 2016, the Cvered Califrnia Bard apprved the psting f a prpsed amendment t the Navigatr Prgram Regulatins. The prpsed amendment requires : Cvered Califrnia t cver the fingerprinting csts fr Certified Enrllment Cunselrs. Cvered Califrnia prvide training t cunselrs n available resurces fr cnsumers wh require tax advice and assistance with tax preparatin. Cunselrs prvide infrmatin regarding the prcess f filing Exchange eligibility appeals. Cunselrs prvide targeted assistance t serve underserved and vulnerable ppulatins, as identified by the Exchange, within the Exchange service area. 6

8 Cunselrs prvide referrals t the apprpriate agency fr enrllees with a grievance, cmplaint, r questin regarding their health plan, cverage, r eligibility determinatin. Cunselrs prvide cnsumers with referrals t licensed tax advisers and premium tax credit recnciliatins. Cunselrs infrm cnsumers that they are nt acting as tax advisrs r attrneys and cannt prvide tax r legal advice within their capacity as Certified Enrllment Cunselrs. 7

9 Cunselrs have the ptin f prviding gifts fr purpses ther than as an inducement fr enrllment. The value f gifts must nt exceed a nminal value equal t r less than $15, either individually r in the aggregate, when prvided t that individual during a single encunter. Cunselrs still may nt prvide gifts f any value t induce enrllment. Cmments were received abut certified tax preparers and gifts. The language was changed t accmmdate the cmments. Request Bard apprval t adpt the amendment 8

10 Prpsed Amendments t the Navigatr Grant Prgram Regulatins: 6658 (d) Csts (1) The Exchange shall pay the csts incurred by individuals whse duties require fingerprinting under subdivisin (a) f this Sectin. until December 31, After December 31, 2015, backgrund check csts fr individuals seeking certificatin under this Article shall be paid by the Certified Enrllment Entity. 9

11 Prpsed Amendments t the Navigatr Grant Prgram Regulatins: 6660 Training Standards (b) (3) The tax implicatins f enrllment decisins and the available resurces fr cnsumers wh require tax advice and assistance with tax preparatin; 10

12 Prpsed Amendments t the Navigatr Grant Prgram Regulatins: 6664 Rles and Respnsibilities (a) (8) Fr Certified Enrllment Entities nly, maintain a physical presence in the state f Califrnia s that face-t-face assistance can be prvided t applicants and enrllees; and (9) Prvide infrmatin regarding the prcess f filing Exchange eligibility appeals; 11

13 Prpsed Amendments t the Navigatr Grant Prgram Regulatins: 6664 Rles and Respnsibilities (a) (9) (10) Prvide referrals t licensed tax advisers, tax preparers, r ther resurces fr assistance with tax preparatin and tax advice related t cnsumer questins abut the Exchange applicatin and enrllment prcess, exemptins frm the requirement t maintain minimum essential cverage and frm the individual shared respnsibility payment, and premium tax credit recnciliatins; 12

14 Prpsed Amendments t the Navigatr Grant Prgram Regulatins: 6664 Rles and Respnsibilities (a) (11) Infrm each cnsumer that Certified Enrllment Entities and Certified Enrllment Cunselrs are nt acting as tax advisrs r attrneys when prviding enrllment assistance and cannt prvide tax r legal advice within their capacity as a Certified Enrllment Entity r Certified Enrllment Cunselr; 13

15 Prpsed Amendments t the Navigatr Grant Prgram Regulatins: 6664 Rles and Respnsibilities (a) (12) Prvide targeted assistance t serve underserved r vulnerable ppulatins, as identified by the Exchange, within the Exchange service area; and (13) Cmply with any applicable federal r state laws and regulatins. 14

16 Prpsed Amendments t the Navigatr Grant Prgram Regulatins: 6664 Rles and Respnsibilities (h)(11) Prvide gifts, including gift cards r cash r prvide prmtinal items that market r prmte the prducts r services f a third party, t any applicant r ptential enrllee as an inducement fr enrllment. The value f gifts prvided t applicants and ptential enrllees fr purpses ther than as an inducement fr enrllment must nt exceed nminal value, either individually r in the aggregate, when prvided t that individual during a single encunter. 15

17 Prpsed Amendments t the Navigatr Grant Prgram Regulatins: 6664 Rles and Respnsibilities (h)(11) The nminal value is equal t r less than $15. Gifts f nminal value may nt include beer, wine, liqur, cigarettes, tbacc, r lttery tickets Gifts, gift cards, r cash may be prvided fr the purpse f prviding reimbursement fr legitimate expenses incurred by a cnsumer in effrt t receive Exchange applicatin assistance, such as, but nt limited t, travel r pstage expenses; 16