HHS could play large regulatory role in health exchanges

The U.S. Department of Health & Human Services likely will be running exchanges in at least half of all states, which could set up a complicated assortment of federal and state requirements for payers to follow.

Although states still have until mid-December to tell HHS if they want to run their own exchanges or default to the federal version, it appears the agency will have a large exchange role in about 30 states. And that means HHS will be taking on a new regulatory role, managing a massive IT rollout and ensuring payers comply with all rules, reported Politico.

The biggest test facing HHS is creating a national IT infrastructure that communicates with the varied systems of insurers and state Medicaid systems. Plus, state consultants and insurance regulators already are warning than an electronic system (System for Electronic Rate and Form Filing) used by insurers to electronically file proposed plans for exchanges won't be ready for testing next month because federal officials haven't issued certain rules needed to update the software, FierceHealthPayer previously reported.

"For any IT system to interact with that, that's a challenge," Mila Kofman of Georgetown University's Health Policy Institute and former Maine insurance commissioner, told Politico. "For the first time, there's going to be this infrastructure that allows different entities to talk to each other," she added. "It's very complicated and not a quick build process."

What's more, HHS may have to assume some roles traditional for states like certifying whether payers meet exchange requirements, run the appeals process and establish customer call centers.

So it's no wonder why many payers, most of which have well-established relationships with state officials, are fraught with concern over complying with such a myriad of exchanges and regulators.

"There are a lot of rules," Alissa Fox, senior vice president for the Blue Cross Blue Shield Association, told Politico. "If you have federal exchange regulation and state regulation, that's a sure way of having a lot of confusion."

To learn more:
- read the Politico article