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The Centers for Medicare & Medicaid Services (CMS) requires agents to document that they have consent from Affordable Care Act (ACA) consumers when providing assistance.
In this article we’ll cover:
Consent is managed by HealthSherpa for enrollments submitted using HealthSherpa Enrollee Assistance Full-Service account types.
Consent requirements at a glance
CMS requires agents to obtain consent from Affordable Care Act (ACA) consumers when providing assistance.
Consent is made up of two separate parts that are collected and documented at different points in the enrollment journey. These parts are called Consumer Consent and Eligibility Application Review.
For both parts of consent:
CMS requires specific content be included in the documentation
CMS expects documentation to clearly indicate the consumer (or their authorized representative) actively provided consent.
Agents must document and retain consent records for at least 10 years.
Additional information about consent requirements is available within CMS' 2023 Understanding Key CMS Rules and Regulations to Maintain Marketplace Compliance slides, and CMS FAQs: Consumer Consent & Application Review Requirements.
Consumer Consent
Consumer Consent indicates a consumer has granted permission for an agent to provide assistance.
Consumer Consent must be documented before an agent can take actions such as:
Collecting a consumer’s personally identifiable information (PII) to provide a quote
Searching the Marketplace
Helping a consumer shop or apply
Completing an enrollment submission
Making updates to a consumer’s application or plan selection
Checking the status of a consumer's coverage or application
Refreshing an Enhanced Direct Enrollment (EDE) data sync between a Marketplace application and HealthSherpa
Eligibility Application Review
Eligibility Application Review indicates application information and plan selection have been reviewed and approved by the consumer, and attestations have been shared.
Eligibility Application Review must be documented before an agent can take actions such as:
Submitting a new application
Submitting updates or changes to an application
Submitting a plan selection
Submitting updates or changes to a plan selection
Completing or updating an enrollment submission
Documenting & managing consent
To support agents in meeting CMS consent requirements, consent tools are built into the HealthSherpa account. These tools help agents document and manage both Consumer Consent and Eligibility Application Review.
Frequently asked questions
How long does consent remain valid?
CMS does not specify how long consent documentation remains valid. For additional information, see question 5 within the CMS FAQs: Consumer Consent & Application Review Requirements document.
Additional resources
For help using HealthSherpa or for other assistance, contact Agent Support. Agent Support is available by phone at (888) 684-1373, by email at Agent_Support@HealthSherpa.com, or by chat directly from your account.