HHS Releases Health Insurance Exchange Regulations July 25, 2011 CMA, Health Care Reform access to care, health care reform, Health insurance exchange 0 The U.S. Department of Health and Human Services (HHS) has unveiled proposed regulations that create a framework to assist states in building health insurance exchanges, a key feature of the federal health reform law. The exchanges are state-based competitive marketplaces where individuals and small businesses can purchase standardized health insurance products beginning in 2014. About 11.5 million people are expected to use them the first year, reaching 24 million by 2019, according to Congressional Budget Office estimates. The proposed rules offer states guidance and options on how to structure their exchanges, giving them the flexibility they need to design exchanges that fit their unique insurance markets. For example, states are allowed to decide whether their exchanges should be local, regional, or operated by a nonprofit organization, how to select plans to participate, and whether to partner with HHS to split up the work. Twelve states, including California, Connecticut and Maryland, have already enacted laws creating state-based health insurance exchanges. Massachusetts and Utah already had exchanges before the federal law was passed. California established its exchange, the California Health Benefit Exchange, in September 2010. CMA is working with stakeholders to make sure that there is a broad choice of health plans and physicians participating in the exchange. To ensure appropriate access to care, CMA is advocating that the rates be risk-adjusted and adequate to cover the costs of providing care. CMA is also weighing-in on the medically necessary services that must be included in the essential benefits package. Comments are closed.
