CMS proposes financial, consumer protections for insurance exchanges

With open enrollment quickly approaching, the Centers for Medicare & Medicaid Services on Friday released a proposed rule to ease the operation of health insurance exchanges, also known as health insurance marketplaces, and give states more flexibility.

"The release of these guidelines signals that we're ready to build on our ongoing efforts and ensure that the new systems are fiscally sound," CMS Administrator Marilyn Tavenner said in an announcement.

To safeguard federal funds and protect consumers, the rule would ensure effective and efficient oversight of state-based marketplaces, as well as a progressive approach to the oversight of federally facilitated marketplaces, according to a related fact sheet. For example, states would have to submit to U.S. Department of Health & Human Services financial and operational reports to demonstrate the appropriate use of federal funds.

Under the proposed rule, CMS would amend the definitions of "small employer" and "large employer" so each state can limit small employers to having no more than  50 employees until 2016.

And acknowledging that some consumers who will seek coverage through an exchange do not have bank accounts or credit cards, the proposed rule would require a qualified health plan accept paper checks, cashier's checks, money orders and refillable pre-paid debit cards so all individuals can pay their monthly premiums.

The rule also would allow a state to operate a state-based small-business health options program (SHOP) while HHS would run the state's individual market federally facilitated marketplace.

Earlier this month, HHS postponed until 2015 the implementation of federally run SHOP exchanges.

CMS will publish the proposed rule in the June 19 Federal Register and the public will have 30 days to comment, according to the fact sheet.

To learn more:
- here's the CMS announcement
- check out the fact sheet and proposed rule (.pdf)

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