HHS Proposes Health Insurance Exchange Rules

The Obama administration has caved on its hard deadline of January 2013 to certify state health insurance exchanges (HIEs), and is now proposing that state exchanges can receive "conditional approval" if it appears that they are making progress towards becoming fully operational by January 2014.

The change is one of several included in a proposed rule that was introduced Monday. According to officials at the Department of Health and Human Services (HHS), the proposed guidelines introduce a framework to provide greater flexibility and assist states in building HIE websites, which serve as state-based competitive marketplaces where individuals and small businesses will be able to purchase private health insurance.

According to the document, "although the statute requires HHS to approve state exchanges no later than January 1, 2013, there will be systems development and contracting activities that continue to occur in 2013 after the statutory deadline for approval. In order to accommodate states that are making progress towards the operational date of January 1, 2014, HHS may issue a conditional approval."

The document went on to say that conditional approval assumes that the state exchange would be operational by January 1, 2014 "even if it cannot demonstrate complete readiness on January 1, 2013."

During a press briefing, HHS officials reiterated that by January 2014 each state will have an operational HIE, but noted that some states are further along in establishing them. Officials also said if states are unable or unwilling to establish a state exchange, the federal government will step in to establish a state exchange to meet the January 2014 deadline.

Additionally, a framework has been established to transfer federally operated HIEs to states, which will give states more time to assume responsibility for their exchanges, said Steve Larsen, HHS director for the Center for Consumer Information and Insurance Oversight.

"A state, under the proposed regulation, can decide that although it may not be ready in January 2014, they can transition into a state-based exchange at a later point in time as long as they provide us with 12 months' notice and essentially a transition plan to get from the federal facilitated exchange that would be in place on 2014, and the one that may go into effect, say, in January 2015," Larsen said.

He also noted that an evaluation of the exchanges will be made in January 2013 to measure the relative readiness of key state exchange functions such as their certifying plans, and financial management, IT, and Web capabilities.

According to HHS, the proposed new rules will offer states guidance and options on how to structure their exchanges in two key areas:

-- Setting standards for establishing exchanges, setting up a small business health options program (SHOP), performing the basic functions of an exchange, and certifying health plans for participation in the exchange.

-- Ensuring premium stability for plans and enrollees in the exchange, especially in the early years as new people come in to exchanges to shop for health insurance.