Things You Didn’t Know Were in MEEG-related Regulations
This key piece of oversight of State-based Exchanges resides in MEEG’s regulations.
What is Periodic Data Matching for Medicare, Medicaid/CHIP, Basic Health Plan and Death?
This Front Office Person got his or her start in CCIIO in the Verifications Division.
Who is Janny Frimpong?
This type of income calculation is used to verify Medicaid/CHIP eligibility, which is why Equifax’s very recent payroll records come in handy.
What is current income?
While investigating high Hub call volumes this past OE, it was discovered that this FFE application pathway was making Hub calls when it shouldn’t have made any at all. (This was promptly fixed.)
What is Inbound Account Transfer (AT)?
OPM performs this type of verification. The only source we have to verify the over the 150 million Americans that get their coverage this way. If a match comes back you might not be eligible for APTC/CSRs.
What is Employer sponsored coverage (or insurance)?
In 155.320(d)1, this program needs to be periodically checked for dual enrollment, but practically it only applies to 2 State-based Exchanges that operate it.
What is the Basic Health Program?
This contractor was the original contractor responsible for building the Exchange eligibility pieces. It didn’t end well.
Who is CGI?
This is the official name for the “buffer” that allows a person to be assessed or determined eligible for Medicaid or CHIP even if they told us that they expect their income to be 5% above the program’s FPL threshold.
What is the “5% Disregard”?
An upgrade to this service (to version 37) caused headaches for the Account Transfer Team…and everyone else.
What is Verify Lawful Presence (VLP) Service?
An FFE consumer is only liable for payback of APTC if dually enrolled in these coverages.
What are Medicare and QHP/APTC/CSRs?
In addition to death and enrollment in Medicare, Medicaid/CHIP or a BHP (Basic Health Plan), this is information must/ can an Exchange update by periodically examining available data sources described in §§155.315(b)(1) and 155.320(b).
What is basically anything affecting QHP or APTC/CSR eligibility? From 155.330(d)(2)
This former Verifications Division team member is now the Insurance Commissioner of PA.
Who is Jessica Altman?
This standard form, created and defined by Treasury (Bureau of the Fiscal Service), is used Government wide for all reimbursable agreements at the trading partner level, including agreements between agencies or within agencies, grant-related agreements and assisted acquisitions. MEEG enters into these agreements with our federal Trusted Data Sources who require reimbursement (SSA, DHS, OPM, VHA).
What is an Inter-Agency Agreement (IAA)?
Without these agreements in place that the Verifications team oversees, there would be no data to make eligibility determinations.
What are Inter-Agency Agreements, or Computer Matching Agreements?
While you aren’t ineligible to get a QHP because you have coverage through this program, an issuer could theoretically get in trouble for knowingly enrolling you.
What is Medicare?
Q: 45 CFR 155.405 requires that consumers be allowed to submit an application through four different channels. Apart from the website, these are the three other channels.
*Bonus Q (additional 200): The regs at 45 CFR 155.335 require that consumers be allowed to report a change in circumstance through at least 3 of those 4 channels. This is the optional channel for the Exchange to provide as an option for reporting changes.
What are the phone, mail and in-person? *For change reporting, it is optional for the Exchange to accept reports of changes via mail.*
These were the original name of App 2.0 and the name of the broader project that prompted its creation.
What is “EZ-App” created as part of “Marketplace Lite”?
Generally, someone is ineligible to enroll in a QHP if they are incarcerated – but there’s one exception. This is the official name for the kind of incarceration that doesn’t disqualify you from enrolling in a QHP.
What is incarcerated pending disposition of charges?
What if – A consumer and her spouse enrolled in 2020 Marketplace coverage with APTC during Open Enrollment. On August 23, they adopt a new baby. On October 17, they update their application to add their new child to coverage and to report an increase in household income that will significantly decrease the amount of APTC they’re eligible for. When will their new child’s coverage start and when will their new APTC amount be applied?
New child can be added to the couple’s current plan or enrolled in a separate plan; either way, coverage will be retroactive to August 23, based on 155.420(b)(2)(i). (Alternatively, the couple can request that the new child’s coverage start first of the month after their date of plan selection or regular coverage effective dates based on plan selection.) New APTC amount will take effect on November 1, based on 155.330(f)(3).
Alissa Deboy was a former group director in the group that would become MEEG. She currently works in this Center in CMS where she is the current Directory of the Disabled and Elderly Health Programs Group (DEHPG).
What is CMCS?
This written agreement documents terms under which a computerized comparison of two or more automated systems of federal or non-federal records can occur to ensure the privacy and integrity of data exchanges, and allows the Hub to connect to federal Trusted Data Sources.
What is a Computer Matching Agreement (CMA)?
What if – Same scenario as above, but in addition to their adoption and income change, the couple also reports that they moved on October 3. Does that change anything about when their new child’s coverage will start or when their new APTC amount will be applied? When will the couple’s new coverage start?
Coverage for child will still be retroactive to August 23, and new APTC amount will still apply on November 1; consumers may have to call the Call Center to request that coverage related to their move take effect prospectively.