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Meaningful Health Care Informatics Blog

Nov 19 2012   9:29PM GMT

Extensions provided by HHS for the state Health Insurance Exchange (HIX)

Posted by: RedaChouffani

The secretary of the Department of Health and Human Services (HHS) is still faced with the challenge of getting states to participate in health care exchanges, despite the end of the election season and removal of much of the doubt around existing health care laws and reforms.

This was a key area of discussion during the governor’s conference earlier this month. Many republican governors requested an extension as the deadline approached for submitting a letter of intent to participate in the key state health care plan exchange program. HHS Secretary Kathleen Sebelius moved the deadline to Dec. 15, 2012, in response to that.

A limited set of states have already submitted their letters of intent for their state exchanges, along with others who have publicly stated their intent. The federal government has already provided grants for assisting different states in the planning stages for the exchanges.

There are clearly some benefits that consumers can take advantage of due to the program, though there has been significant criticism of the exchange plans because of the requirements set under the law. When purchasing online, many of use prefer to have access to pricing details, and comparative reviews of products with end user feedback. The state exchange will offer similar benefits to health care plan shoppers. According to the requirements of the state exchange, the following are some of the functions that would be made available:

Section 1311(d)(4) specifies core functions that an exchange must meet:

  • Certification, recertification and decertification of plans
  • Operation of a toll-free hotline
  • Maintenance of a website for providing information on plans to current and prospective enrollees
  • Assignment of a price and quality rating to plans
  • Presentation of plan benefit options in a standardized format
  • Provision of information on Medicaid and Children’s Health Insurance Plan (CHIP) eligibility and determination of eligibility for individuals in these programs
  • Provision of an electronic calculator to determine the actual cost of coverage taking into account eligibility for premium tax credits and cost sharing reductions
  • Certification of individuals exempt from the individual responsibility requirement
  • Provision of information on certain individuals identified in Section 1311 (d)(4)(I) to the Treasury Department and to employers
  • Establishment of a Navigator program that provides grants to entities assisting consumers as described in Section 1311(i) 

Additional exchange functions include:

  • Presentation of enrollee satisfaction survey results under Section 1311(c)(4)
  • Provision for open enrollment periods under Section 1311(c)(6)
  • Consultation with stakeholders, including tribes, under Section 1311(d)(6)
  • Publication of data on the exchange’s administrative costs under Section 1311(d)(7)


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