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Sebelius Testimony on Paid Obamacare Enrollment Contradicts HHS Guidance

1:01 PM, Mar 13, 2014 • By JERYL BIER
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The above documents make clear that the intention of HHS from the start was that insurers would confirm enrollment only when premiums were actually received.  As to the timing of such confirmations, Section 2.4 of the guidance document issued on October 3 states that "the FFM expects QHP and QDP issuers to send all confirmation transactions by the fifth calendar day of the effective month of coverage."  While HHS has implemented various exceptions, delays and clarifications, there is no indication  that insurers have been relieved of the responsibility to confirm premium payments, although the timing has been stretched, as an Interim Final Rule published in the Federal Register on December 17, 2013 spells out:

The Draft Enrollment Guidance outlines a procedural timeline that specifies that QHP issuers must send enrollment confirmation transactions to the FFE by the fifth calendar day of the effective month of coverage. Instead, the FFEs will accept enrollment confirmation transactions from QHP issuers for coverage beginning on January 1, 2014 throughout the month of January.

HHS has granted flexibility about due dates, effective dates, and the timing of confirmation of enrollments, but not the substance of those confirmations.  If insurers are following the guidance issued by HHS, then the agency has accumulated data on paid enrollments at least relative to the Federal Marketplace.  Some states running their own Marketplaces, such as Maryland, report weekly on the number of paid enrollments.

But as Kathleen Sebelius's testimony demonstrates, HHS is not yet ready to make the federal data on paid enrollments available to the public or even acknowledge its existence.

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