Understanding the Federally-Facilitated Marketplace (FFM) Standards of Conduct & How to Comply

What are the FFM’s requirements for consent to contact?

The Centers for Medicare & Medicaid Services (CMS) Understanding Marketplace Compliance Rules & Regulations presentation laid out additional requirements for life and health insurance brokers to obtain consent to contact prior to providing assistance. This article will cover the verification and consent health and life insurance brokers must obtain from their clients when assisting with Marketplace and ACA enrollments.

The consent to contact guidelines include: 

“Agents and brokers should only make updates to a consumer's application or policy at the direction of the consumer. The Marketplace standards of conduct specify that agents and brokers must obtain the consent of an individual, employer, or employee prior to providing assistance to Marketplace consumers. This includes but is not limited to: 

1. Conducting a search for consumer applications using an approved Classic Direct Enrollment (DE) or Enhanced Direct Enrollment (EDE) website.
2. Helping the consumer apply for Marketplace coverage or financial assistance or enrolling the consumer in a Marketplace-qualified health plan (QHP).
3. Checking the status of the consumer’s coverage and making updates throughout the year via HealthCare.gov, approved DE or EDE websites, and/or the Marketplace Call Center.”

Currently, the CMS does not require a standard format or process for obtaining or maintaining records of consent. Agencies and brokers can choose to create their own form or use a Broker of Record (BOR) form from an issuer or state Department of Insurance (DOI). The record of consent should include the following information:

• The individual’s, employer’s, or employee’s name.
• The date the consent was given.
• The name of the agent(s) or broker(s) to whom consent was given.

At this time, any consent given does not expire, and the CMS shared that “the consent may last indefinitely unless the individual, employer, or employee revokes it.” Any documentation of the consent must be secured and retained for a minimum of 10 years.

Using an AMS to Help You Comply with the CMS Consent to Contact Regulations

All health and life insurance brokers that anticipate selling or renewing Marketplace and ACA plans for individuals and groups must obtain consent. Brokers can obtain consent in one of three ways:

• Verbally. You can gather this consent over the phone. It’s best practice to use a line that is recorded, which will also allow your agency to comply with other regulations of the CMS Final Rule 2023. The CMS recommends that brokers read “a script that contains, at a minimum, the required elements, and they should memorialize that the required consent was obtained.”
• Electronically. You can gain this consent via email or through an electronically submitted form (see above for options).
• In Person. A client may verbally state their consent or sign a form. It’s best practice to record their consent (written or verbal) and retain it for your records. 

Obtaining consent is one part; the other part is maintaining and managing that record of consent. Some places agencies can store these records are:

• Local filing cabinet for written records.
• Electronically-based file folders or a cloud-based file repository (i.e. Dropbox, Google Drive) for electronic files (including recordings).
• An agency management system (AMS) or CRM.

A local filing cabinet can allow ease of access for your employees when they’re in the office, but they cannot be accessed on the go. Additionally, all local filings must comply with HIPAA guidelines to ensure safety and security. 

A cloud-based file repository or electronic file folder makes the recordings more accessible, but there’s no way to tie the call recordings to client records.

Using an AMS or CRM makes storage and access more secure and efficient by attaching the record of consent directly to the client’s profile. This allows you to centralize your data to one location, thus simplifying access and adding efficiencies to your customer service and data management processes. 

Obtain & Store Your Consent to Contact Records with AgencyBloc

AgencyBloc is the #1 Agency Recommended Management Platform for health and life insurance agencies. Agencies utilize AgencyBloc’s industry-specific AMS to house all their client data, including essential documents like consent to contact records. 

How to Obtain Consent to Contact from Clients Using AgencyBloc

Gather consent from your individual and group clients electronically with AgencyBloc:

• Use AgencyBloc’s Email Marketing tool to send a mass email to all of your qualifying clients to introduce the new regulations, share the form, and obtain their consent. You can link directly to your agency’s form or the BOR form. This helps you gather consent records from your existing client base.
• Use AgencyBloc’s Email Forwarding and Outlook Email Sync integration to automatically attach any signed consent to contact records from your agent’s email to the contact’s profile in AgencyBloc.
• Use AgencyBloc’s Automated Workflow tool to create tasks to remind agents to obtain consent whenever they begin working with a new individual or client. This allows your team to integrate these new regulations into your existing processes seamlessly. 
• Leverage AgencyBloc’s Zapier integration to send signable documents from customizable document tools, like DocuSign, directly to your clients. Once signed, the record will automatically attach to your client’s profile in AgencyBloc.

How to Manage Consent Records in AgencyBloc

Upload your electronic consent files directly to the contact’s record in AgencyBloc to centralize your documentation and improve accessibility for your agency. This creates a digital paper trail your team can rely on and use should the need arise. 

AgencyBloc integrates with several applications that specialize in call recordings. Set up the integration and gain consent over the phone. These recordings are then attached to the contact’s record in AgencyBloc. 

Using an AMS like AgencyBloc to obtain consent and manage your consent to contact records allows your agency to stay compliant with government regulations, provide a higher level of customer service, and add more value to your new and existing client relationships.

Posted by Allison Babberl on Monday, July 3, 2023 in Health Insurance