CMS Proposed Rule on Health Benefit Exchange Implementation

By: Deborah Bachrach | Megan K. Ingraham | Patricia M. Boozang
– BNA’s Health Insurance Report

In mid-July, the U.S. Department of Health and Human Services (HHS) issued a proposed rule on the establishment of American Health Benefit Exchange (‘‘Exchanges’’) and Qualified Health Plans. These regulations largely codify Affordable Care Act (ACA) requirements, with some notable exceptions. Recognizing that the pace and politics of Exchange implementation varies from state to state, HHS departs from ACA guidance and provides states with three options for Exchange establishment: a state-run Exchange; a federally-run Exchange; or, a new ‘‘hybrid option’’ under which a state and the federal government would share operating authority.

The regulations further indicate that states may go into 2014 with a federally-run Exchange and opt to launch a state-run Exchange at a later date. The regulations and the commentary note that HHS will accommodate state flexibility beyond federal minimums and encourage states to adopt standards that reflect the demands of local markets and ensure that consumers have access to value-based coverage.

In addition to state flexibility, consistent themes throughout the draft regulation are cooperation and collaboration, between states and the federal government, state Medicaid and insurance agencies, and state agencies and Exchanges.

Reproduced with permission from BNA’s Health Insurance Report
Copyright © 2011 by The Bureau of National Affairs, Inc. (800-372-

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