Data Change Windows

During the certification process for plan year 2019, CMS will allow issuers to make changes to their qualified health plan (QHP) Application based on the guidelines below. These changes are in addition to any corrections that CMS identified during its review of QHP Applications.

Issuers may make changes to their QHP Application data without state or CMS authorization until the deadline for initial application submission. After the close of the initial QHP Application submission window, issuers may not add new plans to a QHP Application or change an off-Exchange plan to both on and off-Exchange. Issuers also may not change plan type(s) and may not change QHPs, excluding stand-alone dental plans (SADPs), from a child-only plan to a non-child-only plan. Issuers may only change their service area after CMS approves the change. Additional information regarding service area changes is below. For all other changes, issuers will be able to upload revised QHP data templates and make other necessary changes to QHP Applications in response to state or CMS feedback until the deadline for issuer changes.

After the final deadline for issuer changes to QHP Applications, issuers will only make corrections directed by CMS or by their state. States may direct changes by contacting CMS with a list of requested corrections. Issuers whose applications are not accurate after the final deadline for issuer submission of changes to the QHP Application are required to enter a limited data correction window and may be subject to compliance action by CMS. Issuer changes made in the limited data correction window not approved by CMS and/or the state may result in compliance action by CMS, which could include decertification and suppression of the issuer's plans on HealthCare.gov.

After completion of the QHP certification process, CMS may offer additional data correction windows. CMS will only consider approving changes that do not alter the QHP’s certification status or require re-review of data previously approved by the state or CMS. CMS will offer windows for Small Business Health Options Program (SHOP) quarterly rate updates. A request for a data change after the final submission deadline, excluding administrative changes or SHOP quarterly rate updates, may be made due to inaccuracies in or the incompleteness of a QHP Application, and may result in compliance action. Discrepancies between the issuer’s QHP Application and approved state filings may result in a plan not being certified or a compliance action if CMS has already certified a plan as a QHP. Issuers that request to make changes that affect consumers may have their plans suppressed from display on HealthCare.gov until the data is corrected and refreshed for consumer display. The availability of the windows is listed in the “Plan Year (PY) 2019 Data Change Windows” section below.

Before entering a data correction window, issuers must request to make the change and receive approval from CMS and their state. For QHPs in direct enforcement states, the CMS Form Filing team, rather than the state, must authorize data changes.

To request a data change, including service area changes, issuers are required to provide a justification for each requested change. Issuers in Federally-facilitated Exchange (FFE) states must submit signed evidence of state or CMS Form Filing approval. Issuers are responsible for ensuring that requested changes are in compliance with federal QHP certification standards set forth in the Patient Protection and Affordable Care Act (PPACA), federal regulations, and all other guidelines discussed in the Letter to Issuers.

Data Change and Service Area Change Requests

Issuers must submit data change requests (DCRs) for any service area changes made after the initial submission deadline, and for all changes made after the final submission deadline.

How to request a data change after the final data submission deadline:

1. Gather the necessary documentation
a. DCR Supplement
b. State Authorization (FFE issuers) 

2. Submit data change request and associated supporting documentation to CMS via the Plan Management (PM) Community
a.   CMS will deny data change requests that do not include all required elements.
b. Issuers may only submit one change per data change request. 

3. Wait for CMS approval

4. Make changes during data correction window

Changing Plan Data

  • During the initial application submission window: Issuers may make any changes to their data without CMS or state authorization, including adding/removing plans or changing plan type.
  • After the initial application submission window closes: Issuers may not add plans or change plan type. A data change request to CMS is required for changes to service area, and plan withdrawal forms are required to remove plans. For all other changes, issuers are not required to submit data change requests or document state or CMS Form Filing authorization to CMS.
  • After the final application submission deadline: No data changes are allowed prior to certification. Issuers will have a final opportunity to withdraw plans during the plan confirmation process. CMS may allow issuers to make critical post-certification data corrections in order to correct data display errors on HealthCare.gov and align QHP plan display with products and plans approved by the state. Post-certification data corrections require data change requests, CMS approval, and state approval. Allowable changes will occur during periodic, scheduled data correction windows.

Plan Year 2019 Data Change Windows

CMS will offer the following three data change windows for issuers to request and submit critical QHP, including SADP, data changes for PY2019 certified plans only. These windows are limited to SHOP quarterly rate updates and to correct CMS-approved critical plan data that displays to consumers, align QHP data with products and plans as approved by the state, or to respond to correction(s) as requested by CMS.

Data Change Request Due Date

URRT Submission Deadline for Issuers in a State Without an Effective Rate Review Program

URRT Submission Deadline for Issuers with an Effective Rate Review Program

Submission/ Transfer Window for Approved Data Changes

Approximate Data Refresh Date

January
(4/1/19 effective dates)

January 9, 2019

December 15, 2018

January 16, 2019

January 16-17, 2019

Prior to February 16, 2019

April
(7/1/19 effective dates)

April 10, 2019

March 15, 2019

April 17, 2019

April 17-18, 2019

Prior to May 16, 2019

July
(10/1/19 effective dates)

July 10, 2019

June 15, 2019

July 17, 2019

July 17-18, 2019

Prior to August 16, 2019

 NOTE: The dates listed in this table are subject to change.

Criteria for Allowable Changes:

  • CMS will only consider approving changes that do not alter the QHP's certification status or require re-review of data previously approved by the state or CMS.  
  • Rate and service area changes will not be permitted unless the issuer can demonstrate specific critical issues resulting from data entry errors.
  • Examples of changes that CMS may consider approving are:    
    • Corrections to the payment redirect URL and other URLs; 
    • Changes to plan names for all issuers, and issuer marketing names for SHOP issuers; 
    • Minor changes to cost-sharing information and limits explanations; and
    • CMS requests for data corrections.  

NOTE: Issuers must make all changes to administrative data, such as customer service numbers, in HIOS Plan Finder. CMS does not require a data change request for administrative data changes made in HIOS Plan Finder.

Process for Requesting Changes to QHP and SADP Data:

  • For issuers in Federally-facilitated Exchange (FFE) states
    • Issuers must submit requests in the Cases tab of the Plan Management (PM) Community by no later than the “Data Change Request Due Date” listed in the table above for each window. 
    • Requests must include documented approval by the state regulator, or for issuers in direct enforcement states, CMS Form Filing. 
    • CMS will respond to data change requests via email from Marketplace_HelpDesk@lmi.org
    • Once CMS approves a change, the issuer must resubmit their templates during the “Submission/Transfer Window for Data Changes” noted in the table above. Issuers will be able to submit changes between 8:00 a.m. ET on the window start date and 6:00 p.m. ET on the window end date.
  • For issuers in states performing plan management functions
    • Issuers must submit requests in the Cases tab of the PM Community by no later the “Data Change Request Due Date” listed in the table above for each window.
    • Issuers should concurrently submit requests to their state to begin the state approval process for the requested changes sent to CMS.
    • CMS will respond to data change requests via email from Marketplace_HelpDesk@lmi.org
    • QHP issuers in states performing plan management should work with their state to secure state approval and to request reopening SERFF binders once changes are approved. Issuers in states performing plan management should contact their state for the revisions submission deadline prior to 3:00 p.m. ET on the transfer deadline noted in the table above.
  • For issuers in State-based Exchanges using the Federal Platform (SBE-FP)
    • Issuers in SBE-FPs should direct data change requests to their State Exchange for approval. CMS will not review requests for changes from issuers in SBE-FPs. SBE-FP issuers should contact their state for the revisions submission deadline prior to the SBE-FP transfer deadline noted in the table above. 

Issuers MUST include the following in their requests:

  • Completed data change requests in the PM Community should include:    
    • HIOS Issuer ID
    • Issuer Name
    • Issuer State
    • Impacted Plan ID(s)
    • A detailed description of the QHP data change requested:    
      • Specific information about data fields that require revisions:  
        • Issuers requesting Plans & Benefits, Business Rules, or Service Area Template changes must complete the DCR Supplement (see below). 
      • Details about the revisions needed, including original and revised values.
    • Justification for why the change is required.    
      • If the first justification is chosen, issuers must include copies of the relevant section of their form filing.
      • If the second justification is chosen, issuers must include screenshots of data errors.
  • The justification must be signed by an authorized representative of the issuer. If the Issuer received notification directly from CMS about needed data changes, include documentation of the CMS request (i.e., an email or communication) in your data change request.
  • Evidence of state approval, including specific content about the requested data changes if operating in an FFE state, OR approval from CMS Form Filing if a QHP or dual issuer in a direct enforcement state.   
    • The CMS Form Filing team requires the State Authorization of QHP Data Change Request Form to be submitted along with the other documentation of the requested change for authorization consideration. 
  • The DCR Supplement to the Data Change Request Form—if requesting a Plans & Benefits, Business Rules, or Service Area Template change.     
    • This workbook has four tabs: "P&B Benefits Package," "P&B Cost Share Variance," "Business Rules," and "Service Area."    
      • Fill out the tab that corresponds to the template you are requesting to change. All other tabs should be blank. 
      • Each tab includes fields to be filled out as appropriate to the intended changes. All fields must be completed for all requested changes. 

Reasons for Potential Compliance Action:

  • A request for a data change, excluding administrative changes, indicates the presence of inaccuracies and/or the incompleteness of a QHP Application. Because this calls into question an organization's ability to submit correct data and the validity of the final application, data changes made during a data change window may result in compliance action and/or a work plan for the issuer to address the ability to submit correct data. Issuers may face further compliance action if the work plan instructions are not followed, if there are continued inaccuracies, or if there are unauthorized data changes made. 
  • Issuers with approved changes must ensure that they remain in compliance with all certification standards, including non-discrimination and cost-sharing reduction requirements. CMS strongly recommends that issuers check their templates using CMS's Application Review Tools, including the Cost Sharing Tool and Data Integrity Tool. CMS will consider compliance action(s), including removing the plans from sale on-Exchange, if the change results in a plan no longer meeting a standard.

Data Change Request Instructions and Supporting Documents:

PY2019:
PY2020: