policy

As discussed in our meeting June 26, 2014, the Association for Community Affiliated Plans (ACAP) thanks you for considering our concerns regarding how a recent change in the interpretation of guaranteed availability has changed the reporting requirements for our plans, specifically related to the Rates and Benefits Information System (RBIS) submission due July 11, 2014.

ACAP is an association of 58 not-for-profit and community-based Safety Net Health Plans (SNHPs) located in 24 states. Our member plans provide coverage to approximately 11 million individuals enrolled in Medicaid, the Children’s Health Insurance Program (CHIP) and Medicare Special Needs Plans for dually-eligible individuals. Nationally, ACAP plans serve roughly onethird of all Medicaid managed care enrollees. Sixteen of ACAP’s Safety Net Health Plan members have elected to participate in the Marketplaces in 2014.

Background

As discussed in our letter addressed May 20, 2014, guidance related to guaranteed availability in past years did not include a clear requirement that issuers selling Qualified Health Plans (QHPs) through the Marketplaces also sell those products off the Marketplace.

All issuers applying to participate in the Federally-facilitated Marketplace (FFM) in 2014 were allowed to indicate to HHS that they were applying for QHP certification to sell products only on the Marketplace; other options included off-Marketplace or both on- and off-Marketplace. Issuers applying for certification by State-based Marketplaces (SBMs) were similarly allowed to apply to sell on the state Marketplaces only. CCIIO and states accepted plans’ choices – none of our members participating in the FFM or SBMs were told they could not sell solely through the Marketplaces after indicating they intended to do so, and we have clarified with CCIIO staff that no outreach was conducted to ensure plans corrected an inappropriate choice to sell only on Marketplace.

Those issuers, including many of our plans, applied for QHP certification to sell products only on the Marketplace. RBIS submissions have previously only appeared to be for the purposes of populating Plan Finder, a portal similar to Healthcare.gov, for products sold off of the Marketplace. Prior to clarification provided in the final Exchange and Insurance Market Standards for 2015 and Beyond, release May 16, 2014, these plans did not believe they needed to complete a RBIS submission because they did not believe they were available to the market off of the 2 Marketplace. Furthermore, CCIIO did not clearly communicate with plans this was a required submission prior to ACAP reaching out to CCIIO for further guidance on the submission process.

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