The Department of Health and Human Services has issued extensive guidance for qualified health plans that will participate in state health insurance exchanges, scheduled to start operating in October 2013. HHS also announced approval for exchanges in four more states.
The 57-page guidance focuses on exchanges that the federal government will run, and exchanges done in partnership with states. States that are building their own exchange have more flexibility to apply certification standards and adjust various processes. “We note that the policies articulated in this letter apply to the 2014 coverage year and beyond,” according to the guidance. “In the future, CMS will issue similar letters to provide operational updates to qualified health plan issuers, but we do not intend to issue these letters more than annually.”
Guidance in the letter covers 36 policies in seven categories: plan certification standards, plan certification processes, plan performance and oversight, standalone dental plans, consumer enrollment and premium payment, consumer support, and tribal relations and support.
HHS also has conditionally approved exchanges being developed in partnership with the federal government in Iowa, Michigan, New Hampshire and West Virginia. In total, 24 states and the District of Columbia have received federal approval to partially or fully run their exchanges.
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