HHS Releases Final Exchange Rule

The Health and Human Services Department released its final rule which encompasses the key functions of exchanges related to eligibility, enrollment and plan participation and management. The department received more than 24,781 comments on the proposed rules.

From the release:

“These policies give states the flexibility they need to design an Exchange that works for them,” said HHS Secretary Kathleen Sebelius. “These new marketplaces will offer Americans one-stop shopping for health insurance, where insurers will compete for your business. More competition will drive down costs and Exchanges will give individuals and small businesses the same purchasing power big businesses have today.”

The policies included in the rule give states more flexibility to design and create their exchanges, which will be online marketplaces in which individuals and small businesses will be able to shop for and compare health coverage. Exchanges are scheduled to go live in 2014 under the health reform law.

The rule offers guidance about the options on how to structure exchanges and how to establish a stream lined web-based system for consumers to apply for and enroll in qualified health plans.

Under the final rule, exchanges will coordinate with Medicaid, CHIP, and the Basic Health Program so that an applicant experiences a fluid eligibility and enrollment process regardless of where the application is submitted.

In response to comments, the final rule provides two ways for exchanges to interact with Medicaid agencies for eligibility determinations.  One was was by conducting eligibility for Medicaid and for advance payment of premium tax credits.  A second way is by making a preliminary eligibility assessment and then turning it over to the state Medicaid agency for final determination.

A full fact sheet on the exchange rule can be found here.

This builds upon last year’s distribution of grant funding to 10 states totaling $229 million for insurance exchanges.  Washington State received almost $23 million and Oregon received almost $9 million in that distribution.