PROGRESS CONTINUES IN BUILDING EXCHANGES
UPDATE: NOVEMBER 30, 2012
The Centers for Medicare & Medicaid Services (CMS) is working to build new health insurance marketplaces called Exchanges. Consumers and small businesses in every state (including the District of Columbia) will have access to a marketplace. All Exchanges will launch open enrollment in October 2013.
The FFE, like other Exchanges, will support the following operational functions:
Eligibility & Enrollment
CMS is establishing a system to determine consumer eligibility and a mechanism for consumers to enroll in a qualified health plan (QHP). The FFE will also assist in determining eligibility for Medicaid and the Children’s Health Insurance Program (CHIP).
CMS has completed and released the initial set of business service design documentation that describes the interactions with the Hub for eligibility verifications. CMS has been working with industry experts to define technical rules for enrollment transactions. The goal is to make eligibility determinations paper-free to the maximum extent possible.
All plans that health insurers want to offer in the Exchanges must be certified as a QHP. In the FFE, CMS will coordinate plan management activities with states, including QHP certification, monitoring and oversight, account management, and recertification. Health insurers will begin to submit their applications in April 2013 to be certified as QHPs for the 2014 coverage.
The application that these QHPs will use to become certified is near completion. CMS has worked with the National Association of Insurance Commissioners to standardize the collection of data needed to certify qualified health plans.
Small Business Health Options Program (SHOP) Application
The application for issuers to offer QHPs operating in the SHOP is being developed, as is the application for small employers that would like to provide coverage for their employees through the SHOP. CMS has already released the elements of the issuer application for SHOP. The application elements that CMS has released can be found here: http://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing-Items/CMS-10439.html
CMS has outlined the parameters for managing payment processing across entities. These proposed payment parameters can be found here: http://cciio.cms.gov/resources/regulations/index.html#fm
CMS has completed the initial design and will begin testing of a distributed data processing tool (Edge Server) to support risk adjustment and reinsurance analysis with issuers and States.
CMS will provide consumer support to help purchasers of health insurance determine eligibility and apply for a plan through the Marketplace. CMS will fund a Navigator grant program in FFE states to provide consumers with fair, unbiased help with determining if they are eligible for tax credits, comparing QHPs, and the application process for health coverage. Training modules are under development and Navigator grants will be awarded in June 2013.