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Federal Register / Vol. 86, No. 124 / Thursday, July 1, 2021 / Proposed Rules determinations and are enrolled in coverage in line with the modified PTC
eligibility criteria under the ARP, and then, that this temporary modification no longer applies after taxable year 2022. As part of this process, HHS
would need to ensure the adoption of appropriate procedures, proper approvals, and ongoing oversight. To foreclose the possibility that federal funding and resources will be diverted from efforts to provide direct benefits to consumers made available under recent legislation to optional programs, we are proposing to repeal the Exchange DE
option. This will help ensure that available resources are allocated consistent with administration health care priorities and dedicated to implementation of newly-enacted federal laws that provide greater financial assistance and protections to consumers.
Repealing the Exchange DE option should generally have a minimal impact on states and other interested parties.
States with State Exchanges already could engage with direct enrollment entities preceding the addition of 155.221j. In addition, the FFE has already implemented the direct enrollment program including classic direct enrollment and enhanced direct enrollment, which provides broad availability of non-Exchange websites to assist consumers applying for, or enrolling in QHPs through an FFE or SBEFP with APTC and CSRs, when otherwise eligible.44 Additionally, nothing in the previous regulatory framework prohibited State Exchanges from engaging direct enrollment entities similar to the FFE in order to supplement Exchange operations in their states should they so choose. In fact, although we understand that several State Exchanges have engaged with direct enrollment entities to discuss possibilities for collaboration, State Exchanges and other stakeholders nearly universally cautioned against the Exchange DE option in public comments submitted in response to the proposal. In addition, to date, no state has expressed interest in implementing the Exchange DE option.
Finally, in reviewing 155.221j in line with E.O. 13985 and E.O. 14009, and after further consideration of public comments received when the Exchange DE option was proposed, we have determined that the Exchange DE option is inconsistent with policies described in E.O. 13985 and sections 1 and 3 of E.O. 14009. Consistent with many 44 The FFE direct enrollment pathways are also available in SBEFP states. See 45 CFR 155.220l and 155.221i.

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public comments received when the Exchange DE option was proposed, we believe that shifting away from HealthCare.gov or State Exchange websites as the primary pathway to enroll in and receive information about coverage would harm consumers by unnecessarily fracturing enrollment processes among the Exchange and possibly multiple direct enrollment entities operating in a state. Such a shift would be particularly harmful now when over one million consumers have successfully navigated HealthCare.gov during the COVID special enrollment period to enroll in Exchange coverage.
We also agree with many commenters who noted that a fractured process could foster consumer confusion about how to get covered and what coverage options are available, since consumers could be directed to direct enrollment entities that only offer assistance with a limited selection of products and some of those products may not provide, for example, MEC for consumers.45 Many commenters raised concerns that this consumer confusion or limited product selection through direct enrollment entities could also potentially disrupt coordination of coverage with other insurance affordability programs, including Medicaid and CHIP, which is inconsistent with our no wrong door policy.46 In addition, these consequences could act as an unnecessary barrier to consumers seeking Medicaid or ACA coverage rather than facilitating enrollment, and could have additional downstream impacts including an increased uninsured or underinsured population, or more consumers enrolled in less comprehensive coverage options.
Commenters noted that these downstream impacts could lead to health inequities by disparately impacting certain vulnerable groups that tend to have a greater need for comprehensive coverage or rely more heavily on Medicaid and CHIP. These concerns and the accompanying risks to the health and well-being of vulnerable groups and consumers in general are 45 Multiple commenters cited the following report as support for their comments related to DE entities offering limited plan selection and potential disruptions to coordination of coverage with other insurance affordability programs: https
www.cbpp.org/research/health/direct-enrollmentin-marketplace-coverage-lacks-protections-forconsumers-exposes.
46 This policy is intended to ensure that consumers can complete a single eligibility application to receive determinations of eligibility across multiple health insurance affordability programs, including for QHPs, APTC, CSRs, as well as Medicaid and CHIP. See, for example, sections 1311d4F and 1413 of the ACA.

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heightened as the COVID19 PHE
continues.
By finding the Exchange DE option inconsistent with recent Executive Orders, to ensure that resources are not diverted from fulfilling requirements under the new health care legislation and other initiatives like the COVID
special enrollment period, and because no state has yet expressed interest in implementing the Exchange DE option, we propose to remove 155.221j and repeal the Exchange DE option. As explained in the preamble section regarding user fee rates for the 2022
benefit year 156.50, we also propose to repeal the accompanying user fee rate for FFEDE and SBEFPDE states for 2023. We seek comment on this proposal.
4. Open Enrollment Period Extension 155.410e We propose to amend paragraph e of 155.410, which provides the dates for the annual Exchange open enrollment period in which qualified individuals and enrollees may apply for or change coverage in a QHP. The Exchange open enrollment period is extended by crossreference to non-grandfathered plans in the individual market, both inside and outside of an Exchange, under guaranteed availability regulations at 147.104b1ii. HHS is specifically proposing to alter the open enrollment period for the 2022 coverage year and beyond so that it begins on November 1
and runs through January 15 of the applicable benefit year.
In previous rulemaking, we established that the open enrollment period for benefit years beginning on or after January 1, 2018 would begin on November 1, 2021 and extend through December 15, 2021. In doing so, we indicated a preference for a shorter month-and-a-half open enrollment period, noting our belief that it provides sufficient time for consumers to enroll in or change QHPs and that an end date of December 15th carries the benefit of ensuring consumers receive a full year of coverage and simplifies operational processes for issuers and the Exchanges.47 Accordingly, the annual open enrollment period dates have been set to November 1st through December 15th for the 2018, 2019, 2020, and 2021
plan years. We have observed several benefits using the present open enrollment period dates. Prior enrollment data suggests that the majority of new consumers to the Exchange select plans prior to December 15th so as to have coverage beginning January 1st. After 4 years, we believe 47 See
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82 FR 18346 at 18381.

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