That includes automatic transitions, where beneficiaries are automatically enrolled in another plan they are eligible for. The group outlined standards for states to follow in a June 15 article on the American Medical Association website.
Auto-transitions should meet the following standards:
- A person must provide consent to share information with the entities authorized to make coverage determinations.
- Auto-transitions should only occur if a person is eligible for coverage options that would be of no cost to them after the application of any subsidies.
- Beneficiaries should have the opportunity to opt out of the coverage they are auto-transitioned into.
- People should not be penalized if they are auto-transitioned into a plan they are not eligible for.
- Those eligible for zero-premium marketplace coverage should be randomly assigned among the zero-premium plans with the highest actuarial values.
- Targeted outreach and streamlined enrollment mechanisms promoting health insurance enrollment, which could include raising awareness of the availability of premium tax credits and cost-sharing reductions, and special enrollment periods.
- Auto-transitions should preserve existing medical home and patient-physician relationships whenever possible.
- Those auto-transitioned into a plan that does not include their physicians in network should be allowed to receive transitional continuity of care from those physicians.
