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CCIIO releases final version of the exchange certification process for states

Posted on August 14, 2012 | No Comments

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Key Developments
Implementation Briefs

Today, the Office of Consumer Information and Insurance Oversight, a division within the Centers for Medicare & Medicaid Services (CMS), released the final version of the approval for state-based health insurance Exchanges. An Exchange is an entity that both facilitates the purchase of Qualified Health Plans (QHP) by qualified individuals and provides for the establishment of a Small Business Health Options Program (SHOP), consistent with provisions under the Affordable Care Act (ACA). Exchanges will provide competitive marketplaces for individuals and small employers to directly compare and purchase private health insurance options based on price, quality, and other factors.

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As a wrap-up to 2013, The Commonwealth Fund has published a slew of studies and reports concerning the implementation of the Affordable Care Act (ACA). Several of these publications are highlighted below. The first publication, Realizing Health Reform’s Potential: How Are State Insurance Marketplaces Shaping Health Plan Design?, analyzes how state-based marketplaces (SBM) and state-partnership marketplaces (SPM) utilized their plan certification capabilities to enhance or alter the requirements for plans to participate in the marketplaces. The report examines the following certification areas: inclusion of essential community providers, benefit substitution, and provider networks. The second publication, What’s Behind Health Insurance Rate Increases? An Examination of What Insurers Reported to the Federal Government in 2012–2013, found that increases in healthcare rates from mid-2012 to mid-2013 can predominantly be attributed to medical trends, and a slight increase resulted from rate increases associated with the ACA. The third publication, Realizing Health Reform’s Potential: What States Are Doing to Simplify Health Plan Choice in the Insurance Marketplaces, discusses several policies employed by SBM to help simplify plan choices for consumers. Several of these policies include: incorporating meaningful difference standards (where a plan cannot be offered if it is too similar to one already in existence on the marketplace), limiting the number of plans or benefit designs an insurer may offer in the marketplace, and requiring standardized benefit designs.
On April 9th, the Senate Finance Committee held a confirmation hearing for Marilyn Tavenner to be the Administrator of the Centers for Medicare and Medicaid Services (CMS). Committee members submitted additional questions to Tavenner post-hearing on topics ranging from consumer outreach in state insurance Exchanges to pediatric dental services. Health Reform GPS has compiled a list of the Affordable Care Act related questions submitted by the Senate Finance Committee members. The list contains the name of the Senator asking the question, the question number, and the relevant ACA topic addressed.
A study released by the Council for Affordable Health Insurance (CAHI) found that in 2012, there were 2,271 state insurance laws on the books. According to CAHI, Rhode Island had the most state-mandated insurance laws at 69, with Idaho having the fewest at 13. CAHI found that the national number of state insurance mandates has grown over 167% in the last 20 years, and this increase in noted as being a contributor to the rising costs of health care.
Health insurance exchanges form the backbone of the private insurance reforms called for in the Affordable Care Act (ACA), as they will create a marketplace in each state for small employers and individuals without job-based health insurance to buy comprehensive health coverage, with premium subsidies available for those with low or moderate incomes. As of May 2012, 13 states, together with the District of Columbia, had taken legal action to establish exchanges, through legislation or executive order. State implementing laws are essential to the translation of broad federal policies into specific state and market practices. Overall, the laws in the 14 jurisdictions vary, but they tend to show a common approach of according exchanges much flexibility in how they will operate and what standards they will apply to the insurance products sold. In all states, these "threshold policies" will be followed by policy decisions, expressed through regulations, guidelines, and health plan contracting and performance standards. A new Commonwealth Fund issue brief analyzes the choices being made by the jurisdictions to begin establishing exchanges.
The Obama Administration has rolled out a new, more consumer-friendly name for the Affordable Care Act's (AC'A's) Exchanges - "health insurance marketplaces." The name change is part of a broader outreach effort by the U.S. Department of Health and Human Services (HHS) to encourage consumers to participate in the new marketplaces when they open for enrollment in October 2013.
Late yesterday, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius extended the deadline for states to decide whether to run their own exchange until December 14, 2012. The Republican Governors Association (RGA) sent a letter requesting the extension to Sebelius on Wednesday November 14, 2012, just two days prior to the initial deadline. This is the second time in a week that the Secretary has made extensions to key Exchange deadlines, having also recently extended the deadline to submit the state-run exchange blueprint paperwork (also December 14, 2012) and the deadline of whether a state will choose to partner with the federal government on their exchange (February 15, 2013).
U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius today extended the deadline for states to submit Exchange Blueprint documents, until December 14, 2012. States must still notify HHS of their intent to pursue a state-run exchange by November 16, 2012, but now have an additional month to formally submit the Blueprint. Additionally, the deadline for states to decide on whether to pursue a state-federal partnership Exchange has been extended until February 15, 2013, a full three months beyond the original November 16, 2012 deadline. This decision by HHS should allow states more time to make crucial post-election decisions as to what kind of Exchange they intend to pursue, as well as allow the Administration more time to issue key regulations.
A draft of a multi-state plan application indicates that the Office of Personnel Management intends to allow the Affordable Care Act's (ACA's) multi-state plans to initially participate in part of a state, as opposed to the entire state. This comes as a surprise, as the ACA states that multi-state plans must be offered "in all geographic regions..." According to the ACA provision, these multi-state plans must be operating in 60 percent of states in the first year of an insurance plan's participation. By the fourth year, they must scale up and offer coverage nationwide. These plans will be certified to be offered in all exchanges, so they will not need to apply for separate state certifications. Comments on the draft application are due to OPM by October 22, 2012.
Beginning January 1, 2014, millions of previously uninsured individuals will gain access to health insurance coverage under the Affordable Care Act (ACA). On November 20, 2012, the Obama Administration proposed a series of regulations that move the nation significantly toward full implementation. These proposed rules will be analyzed at greater length in coming GPS Implementation Brief updates. In the meantime, this overview summarizes the major federal implementation matters that the Administration has recently released or is expected to address in policy or program implementation in the coming weeks and months as the 2014 full implementation date approaches. Together, these matters address...
Previous updates have summarized final IRS regulations implementing provisions of the Affordable Care Act that provide premium tax credits to help low- and moderate-income individuals and families buy affordable health insurance through State health insurance Exchanges. The IRS regulations provide that premium assistance tax credits are available to all eligible state residents, regardless of whether their state Exchange is state-operated or federally facilitated. This Update examines a dispute that that has arisen regarding the availability of premium assistance tax credits in federally facilitated state Exchanges.