EXCHANGES: Looking for Help

February 26, 2013
|In Health Insurance Exchanges, Policy & Health Reform
|By GHG Advisors

CMS has posted a Q&A about their willingness to allow states to partner in plan management activities without submitting a blueprint.  This makes a new fourth category of exchanges. So, in addition to state exchanges, partnership exchanges, federally facilitated exchanges, the new fourth category is states willing to cooperate in FFE states.  Basically, CMS has decided to ignore the February 15th deadline for states to note their willingness to partner with CMS.

CMS is looking for a letter from an interested state’s governor or insurance commissioner.  The letter must provide attestations that the state has the operational capacity to oversee plan management activities, benefit packages, plan compliance and complaint resolution, conduct de-certifications and appeals as well as provide technical assistance to health insurance issuers.  In addition, states need to show that they can participate in a one-day review of its operational plans and that they have the capacity to do that.

Once CMS gets the letter, they will initiate a review of the state’s request and sign an agreement with the state to allow the state to have a role in regulating QHPs in the Federal Exchange.  CMS also provided an enticement by noting that CMS can provide funds the state can use to support these additional activities.

This is the answer for states that wanted to avoid filling out the blueprint required in the Partnership Exchange.  While credibility of CMS is challenged, it may just unearth those last states willing to balance their political resistance with their interest in having a hand in controlling health insurance issuers in their states.

 

Resources

Hear Gorman Health Group experts discuss the Federal Facilitated Exchange (FFE) and implications for health plans.

Gorman Health Group Senior Vice President of Public Policy Jean LeMasurier offers a summary of the latest guidance on the state partnership exchange, released on January 3, 2013 from HHS.

Download Jean LeMasurier’s whitepaper on Insurance Exchanges in the ACA.