On March 12, 2012, the Department of Health and Human Services (HHS) published a final rule that outlines a framework for states to establish Exchanges . The final rule combines policies from two proposed regulations that were issued last summer, and addresses eligibility and enrollment in Exchanges as well as employer eligibility for the Small Business Health Options Program (SHOP). According to the final rule, Exchanges will perform a variety of functions, including:
- certifying health plans as “qualified health plans” in order to be eligible to participate in the Exchanges;
- operating a website to facilitate consumer comparisons among plans offered in the Exchange;
- operating a toll-free hotline for consumer support and conducting other consumer outreach and education;
- determining eligibility for premium tax credits and other reductions in cost-sharing; and
- facilitating enrollment of consumers in qualified health plans.
The final rule provides minimum standards that health insurers must meet to participate in an Exchange; however, states are given flexibility in determining the number, type and overall requirements for eligible health plans. HHS will accept further comments on certain sections of the rulemaking, which are issued as an interim final rule, including provisions related to the role of agents and brokers. Future rulemaking will address other areas related to Exchanges, including standards for issuing exemptions from the individual mandate, the definition of essential health benefits and standards relating to quality.