HHS Issues Rules for Health Insurance Exchanges

Written by: JD Cleary
Originally published on March 19, 2012. Last updated July 7, 2015.

Last week, the Department of Health and Human Services (HHS) issued final rules regarding healthrules resized 600 insurance exchanges required under health care reform in 2014.

Changes to Preliminary Regulations

  • Governing boards for state health insurance exchanges are required to have at least one voting consumer representative

  • Health insurance exchanges provided with option to allow HHS to determine eligibility for insurance subsidies

  • Allows states to select Medicaid agency of choice to determine applicant eligibility

  • Health insurance exchanges cannot allow insurance agents to determine eligibility for insurance subsidies or Medicaid

According to a recent Washington Post article, some are concerned with the lack of guidance on how state health insurance exchanges will be established in states unwilling to create their own exchanges.  "There’s no new information on how that would work, what the partnership model would look like or what states would have to pay – and that’s all information many states have anxiously awaited,” said atti Boozang, managing director at Manatt Health Solutions.

Effect of Health Insurnace Exchange Rules for Employers...Small and Large

Health care reform includes the creation of American Health Benefit Exchanges for individuals and Small Business Health Options Program (SHOP) exchanges for businesses with up to 100 employees. The SHOP exchangs will allow small employers to offer coverage from multiple issuers.

Many large employers with employees in multiple states are taking more of a wait-and-see approach to deal with health insurance exchanges in multiple states.  

Have the HHS final and interim rules provided any clarity for you on how health insurance exchanges will work?

Click here to read the rules.


Originally published on March 19, 2012. Last updated July 7, 2015.


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