73.05 Redetermination and notification of eligibility159

Enrollee-reported data.160 If AHS verifies updated information reported by an individual, AHS will: Promptly redetermine the individual’s eligibility in accordance with eligibility standards; Notify the individual regarding the redetermination in accordance with the requirements specified in § 68.00; and Notify the individual’s employer, as applicable, in accordance with § 71.01(e). 156 45 CFR § 155.330(d)(1). 157 AHS satisfies this requirement with respect to Medicare through verification processes described at § 55.02(c) and is deemed compliant with this requirement with respect to Medicaid because of its integrated eligibility system. 45 CFR § 155.330(d)(3). 158 45 CFR § 155.330(d)(2). 159 45 CFR § 155.330(e). 160 45 CFR § 155.330(e)(1). Eligibility-and-Enrollment Procedures Part 7 – Page 68 (Sec.73.00, Sub.73.05) (b) Data matching161 For QHP enrollees: (i) Except as provided in (iii) below, if AHS identifies updated information regarding death, in accordance with § 73.04(a)(1), or regarding any factor of eligibility not regarding income, family size, family composition, or tax filing status AHS will: Notify the individual regarding the updated information, as well as the individual’s projected eligibility determination after considering such information; Allow the individual 30 days from the date of the notice to notify AHS that such information is inaccurate; and If the individual responds contesting the updated information, proceed in accordance with § 57.00 (inconsistencies). If the individual does not respond contesting the updated information within the 30-day period, proceed in accordance with paragraphs (a)(1) and (2) of this subsection, provided the individual has not directed AHS to terminate their coverage under such circumstances, in which case AHS will terminate the individual’s coverage in accordance with § 76.00(b)(1)(ii), and provided the individual has not been determined to be deceased, in which case AHS will terminate the individual’s coverage in accordance with § 76.00(d)(7). (ii) If AHS identifies updated information regarding income, family size or family composition, with the exception of information regarding death, AHS will: Follow procedures described in paragraphs (b)(1)(i)(A) and (B) of this subsection; and If the individual responds confirming the updated information, proceed in accordance with paragraphs (a)(1) and (2) of this subsection. If the individual does not respond within the 30-day period, maintain the individual’s existing eligibility determination without considering the updated information. If the individual provides more up-to-date information, proceed in accordance with § 73.02. (iii) If AHS receives information from the Secretary of the Treasury that the tax filer for the enrollee’s household or the tax filer’s spouse did not comply with the requirements described in § 12.05, AHS when redetermining and providing notification of eligibility for advance payments of the premium tax credit will: Follow the procedures specified in paragraph (a) of this subsection. After a redetermination under this subsection, allow a tax filer to re-attest to compliance with the requirements described in § 12.05 and request a redetermination of eligibility. For Medicaid enrollees, if AHS identifies updated information regarding any factor of eligibility, AHS will 161 45 CFR § 155.330(e)(2). Eligibility-and-Enrollment Procedures Part 7 – Page 69 (Sec.73.00, Sub.73.06) proceed in accordance with the provisions of § 57.00(c).