The U.S. Department of Health and Human Services (“HHS”) released a final rule concerning Health Insurance Exchanges (“HIE”) on March 12, 2012. The final rule will be published in the Federal Register on March 27, 2012. In late March, 2012, the U.S. Supreme Court will hear arguments concerning the constitutionality of the Patient Protection and Affordability Care Act (“PPACA”), which includes the establishment of HIE. Although PPACA may be overturned in whole or in part, the federal regulators are pushing forward with developing and issuing regulations implementing aspects of the law including HIE, which would provide a marketplace for individuals and small businesses to purchase health insurance.
If PPACA is upheld by the U.S. Supreme Court with regard to the establishment of HIE, the following functions will be performed by HIE:
- certifying health plans as qualified health plans to be offered through an exchange;
- operating a website to facilitate comparisons among plans being offered;
- providing a toll-free hotline for consumer support to educate and provide other assistance to consumers regarding exchanges;
- determining eligibility of consumers for enrollment in qualified health plans and for insurance affordability programs; and
- facilitating the enrollment of consumers into an exchange.
The final rule will set forth minimum federal standards that states must meet if they elect to establish and operate their own HIE, including standards relating to eligibility of individuals and employers, minimum standards that health insurance companies must meet to participate and offer qualified health plans through HIE, and baseline standards that employers must meet to participate in the Small Business Health Options Program also known as “SHOP.”
New York State has not yet enacted legislation creating a HIE. The Governor and Assembly have expressed support for the establishment, while leaders of the Republican-controlled Senate have recently proposed establishment of a health insurance exchange study commission.
In the event the portion of the law that includes establishment of a state HIE is upheld, the decision will be followed by a flurry of activity to meet the January 1, 2014 effective date