OMB Reviewing Final Exchange Rule On State, Insurer, Employer Requirements

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A final rule governing requirements states must meet to operate insurance exchanges in 2014 under the health reform law was received by the Office of Management and Budget Feb. 3 for review.

The regulation (CMS-9989-F) is one of five issued as a proposed rule in 2011 to implement the exchange provisions of the Patient Protection and Affordable Care Act, and it is the first to be received by OMB for review. According to OMB, the rule is economically significant.

The proposed rule (76 Fed. Reg. 41866, 7/15/11) from the Department of Health and Human Services would give states flexibility in designing the exchanges. It also would specify requirements health insurers must meet to offer “qualified” health plans in the exchanges. In addition, the proposal would stipulate standards employers must meet to participate in Small Business Health Options Program (SHOP) exchanges (133 HCDR, 7/12/11).

Comments originally were due Sept. 28 on the proposal (CMS-9989-P) but were extended to the end of October. In comments, health insurers said that the exchanges should focus on affordability and efficiency (212 HCDR, 11/2/11).

The health insurance exchanges are a major feature of PPACA. They will be competitive markets in which individuals and small employers can shop for comparable health insurance plans. States have the option of setting up separate SHOP exchanges for small businesses and American Health Benefit Exchanges for individuals, or they can combine the exchanges.

People in households earning between 133 percent and 400 percent of the federal poverty level will be able to get premium tax credit subsidies through the exchanges as well as other cost-sharing assistance, and small businesses that meet PPACA's criteria can get temporary tax credits through the exchanges as well. People in households below 133 percent of the poverty level will be eligible for Medicaid in 2014 under PPACA.

HHS will operate exchanges in states that do not create their own.

For More Information

Information on rules under review at OMB is at Select Department of Health and Human Services as the agency.