HHS exchange rule allows payers to sit on boards

In a major coup for insurers, the Department of Health & Human Services (HHS) issued a proposed rule for health insurance exchanges, allowing payers to hold seats on exchange oversight boards. Also, health plans won't be required to negotiate with states on price or benefit offerings, according to Kaiser Health News

Overall, the rule defers a lot of the exchange-related decision-making to the states. Therefore, payers will be dealing with some states that exercise relatively little control over the plans while other states place strict requirements on insurers before allowing them to sell policies in their exchange, including controlling premiums, reports the Los Angeles Times.

HHS also said it will operate an exchange in any state that does not create its own. In 2013, HHS will either certify that states will be prepared to operate their own exchanges by 2014 or the agency step in to run the federal fall-back exchange. Alternatively, HHS can provide "conditional approval" for states that haven't met all of its criteria by 2013 but are still likely to be ready by 2014, according to The Hill's Healthwatch.

To give people time to understand the exchanges and make their choices, the initial open enrollment period will begin Oct. 1, 2013 and run through Feb. 28, 2014. At that point, insurers must be prepared to provide coverage to anyone who enrolls, notes KHN.

Comments on the proposed rule can be submitted to HHS in the next 75 days. The final rule is expected later this year.

To learn more:
- read the health insurance exchange rule (.pdf)
- see the Los Angeles Times story
- check out the Kaiser Health News article
- read The Hill's Healthwatch story