IT will be key for operation of insurance exchanges

Insurers will know by Nov. 16 how states in which they operate will choose to run their health insurance exchanges--by establishing their own exchange, deferring to a federal exchange (FFE), or by choosing to perform only some services.

The Department of Health & Human Services set the deadline in new guidance issued last Wednesday.

If states can't or won't operate their own exchanges, insurers can sell plans through a federally facilitated exchange, which HHS will administer. HHS said in the guidance that it "will seek to harmonize … policies with existing state programs and laws wherever possible."

Information technology is poised to play a big role in the process, according to the guidance, as each FFE will need to be able to connect with state Medicaid and Children's Health Insurance Program agencies for verification of eligibility for both programs. FFEs also must be able to connect with State-based data sources--such as the State Wage Information Collection Agency and/or a state's unemployment benefits agency--to reaffirm that verification.

Additionally, FFEs will need to be able to electronically transmit application data to and from such agencies

Those insurers operating in states with FFEs will only have to meet basic requirements to sell plans because HHS said it will create an open marketplace exchange. However, HHS officials said they may explore other options in the future, Kaiser Health News reported.

HHS also will analyze all plans to ensure benefit designs don't discriminate and will review new rates and increases for reasonableness, according to the Health Affairs blog.

The amount of progress that states have made toward creating exchanges is varied, as many states await the U.S. Supreme Court's ruling next month. Thus far, 34 states and the District of Columbia have accepted federal grant money to help establish an insurance exchange. But only 15 states have actually taken steps to establish exchanges through legislation or executive order, Reuters reported.

For states operating their own exchanges, HHS provided a blueprint guidance document explaining the steps they must take toward that goal.

Dan Bowman contributed to this article.

To learn more:
- read the HHS guidance (.pdf) and state exchange blueprint (.pdf)
- read the Reuters article
- see the Kaiser Health News article
- check out the Health Affairs blog

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