New guidance on state partnership exchanges, broker registration

The Department of Health and Human Services (HHS) recently provided guidance on how states and the federal government will work together in health exchange partnerships.¹

Health Insurance Exchanges (which the government is now calling Competitive Health Care Marketplaces) are scheduled to open January 1, 2014. States were given the option to run their own exchanges, have the federal government run the exchange for them, or partner with the federal government. To date, seven states have indicated they wish to form partnerships; three have been conditionally approved by HHS. The deadline to decide was February 15, 2013, so final partnership numbers should be available soon. The purpose of the exchanges is to provide a consumer-friendly online marketplace for health insurance.

Under the new guidance — which HHS will add to and refine over time — states will have responsibility for:

• recommending insurance plans for certification as "Qualified Health Plans" (QHP), as well as recertifying and decertifying them
  
  
• performing account management for QHP issuers (serving as point of contact, providing technical and communication assistance, and helping issuers meet federal and state requirements)
  
  
• performing day-to-day oversight and administration of QHP issuers
  
  
• performing risk adjustment, to make sure the plan insurers are able to compete fairly and on an equal playing field
  
  
• performing the same plan management activities for stand-alone dental plans.
  
  

HHS gives states flexibility in certifying "Qualified Health Plans" as long as the process they use is consistent with the policies used by federal-facilitated exchanges (FFEs). States may propose alternative certification processes that meet or exceed FFE standards. HHS has agreed to work with states to agree on processes, to eliminate the need for duplicative HHS reviews. Because all states will need to continue state insurance regulation and oversight for plans both inside and outside the exchanges, HHS will work with states that choose partnerships or FFEs to integrate those states’ reviews into the federal process for certifying QHPs.

HHS will take responsibility, in conjunction with states, for developing standards for collecting and reporting QHP data and for overseeing state certification. It will also oversee aspects of QHP-issuer operations that fall outside of normal state insurance oversight, such as complying with requirements for enrollment transactions.

In addition, HHS has released limited draft documents about registering brokers for the exchanges, and is seeking comments through April 2013. The federal government hopes to begin registering brokers and agents around July 1, 2013.² More information about how brokers can register to work with Exchanges will be available after April.

What you need to know now?

• Impact on brokers — Brokers need to stay on top of exchange implementation so they are aware of the impacts to their clients. They need to be familiar with how states are running their exchanges and how this differs from the federally run exchange, in order to continue to serve as trusted advisors on key employer questions. Brokers will also want to keep an eye on the registration process so that when it becomes available they can register to be brokers on the exchange.
  
  
• Impact on employers — Employers will need to closely follow exchange implementation in their states and understand the options available to their company and workers, because they will be responsible for communicating this information to their employees.
  
  

Qualified Health Plan

• Meet certain criteria for certification issued or recognized by each exchange through which the plan is offered
  
  
• Provide the "Essential Health Benefits" package
  
  
• Be offered by an approved health insurer