HHS offers guidance for states setting up insurance exchanges

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The U.S. Department of Health and Human Services' (HHS) Secretary Kathleen Sebelius has released policies to assist states in building Affordable Insurance Exchanges. Starting in 2014, these one-stop marketplaces will allow consumers and small businesses to choose a private health insurance plan and offer the public the same kinds of insurance choices as members of Congress.

The final rule allows states to decide whether their exchange should be operated by a nonprofit organization or a public agency, how to select plans to participate and whether to partner with HHS for some key functions. The final rule also offers flexibility regarding the eligibility determination process, while allowing small businesses to get coverage through the Small Business Health Options Program (SHOP).

The policies provide states with guidance as they continue to work to build these marketplaces for their residents for operation in 2014. The policies offer guidance about the options on how to structure exchanges in two areas:

  • Setting standards for establishing exchanges, setting up a SHOP, performing the basic functions of an exchange and certifying health plans for participation in the exchange; and
  • Establishing a streamlined, web-based system for consumers to apply for and enroll in qualified health plans and insurance affordability programs.

To finalize the rules, HHS accepted public comment over 75 days to learn from states, consumers and other stakeholders on how the rules could be improved, and HHS modified the proposals based on feedback from Americans.