HHS Releases Additional Guidance on Insurance Exchange Partnerships
On Monday, HHS provided further guidance on the federal-state partnership model for health insurance exchanges that the agency first addressed in a proposed rule issued in July, Modern Healthcare reports (Zigmond, Modern Healthcare, 9/19).
Under the federal health reform law, states by January 2014 must create insurance exchanges that provide coverage options for individuals and small businesses. States can choose to administer their own exchanges -- for which they must have some infrastructure in place by January 2013 -- or have the federal government run the exchanges for them.
However, only about 12 states as of early September had made significant strides toward establishing exchanges, while about 33% were still in the early stages of planning. Some states already have missed a deadline to qualify for some federal funding because they have not yet acted and their legislatures are not scheduled to meet during a regular session before 2013.
HHS officials already have begun talks with state lawmakers about the federal-state partnerships, which would allow the government to assist states in establishing the exchanges without completely taking over operations (California Healthline, 9/12).
Details of Partnership Model
Under the partnership model, states would have the option to follow the so-called plan-management function, the consumer-assistance function, or a combination of both functions. The plan-management function would involve:
- Plan data aggregation and analysis; and
- Plan monitoring and oversight.
The consumer-assistance function would involve:
- Oversight of in-person consumer assistance;
- Management of the Navigator program, which will provide consumers with direct assistance to enroll in a plan; and
- Education and outreach initiatives.
HHS is accepting public comments on the proposed regulations and guidelines through Sept. 28 (Modern Healthcare, 9/19).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.