The Centers for Medicare and Medicaid Services (CMS) has released the Federally-facilitated Marketplace (FFM) and Federally-facilitated Small Business Health Options Program (FF-SHOP) Enrollment Manual for the 2017 marketplace open enrollment period. The manual provides operational policy and guidance on key topics related to eligibility and enrollment activities within the FFM and FF-SHOP, as well as within the SBM-FP, which use the federal platform for eligibility and enrollment platforms.
The terms “FFM” and “FF-SHOP” are used to refer to all individual market Marketplaces and SHOPs that rely on the federal eligibility and enrollment platforms. The information provided in the manual applies to organizations and entities that may be involved in or assist with enrolling a QI or SHOP enrollee into a QHP and/or QDP using the FFM or FF-SHOP eligibility and enrollment functions.
These entities include:
- SHOP SBM-FPs;
- QHP and QDP issuers;
- Agents and brokers (A/B) who are registered with the FFM;
- Navigators, non-Navigator assistance personnel, certified application counselors (CACs), and caseworkers;
- Third-party administrators (TPAs) of QHPs, QDPs, or employer-sponsored coverage;
- Trading partners of QHP and QDP issuers, such as health care clearinghouses.
The manual is effective as of October 1, 2016. All enrollments made on or after October 1, 2016, should be processed in accordance with the operational requirements set forth in the document. CMS intends to update the manual regularly, and publish clarifying bulletins between updates.
Click here to see the complete Federally-facilitated Marketplace (FFM) and Federally-facilitated Small Business Health Options Program (FF-SHOP) Enrollment Manual.