PPACA: NAIC Panel Endorses Exchange Model Act

reconcile the eligibility rules for participation, which are currently based on residence for individual coverage and based on employment for coverage through the SHOP Exchange.”

In the version approved by the Exchanges Subgroup, drafters included a note suggesting that, “At this time, the question remains open whether a State may allow traditional small group coverage to be offered in the Exchange.” The full committee deleted that note from the version of the model that it approved.

The full committee also simplified a section requiring a qualified health carrier to provide information about appeals and external review processes in a “culturally and linguistically appropriate manner.”

In theory, insurance and brokers might want to refer some customers to the exchange system, or possibly have some other kind of relationship with an exchange. The model approved by the full committee says of producers only that a state may need to consider whether an exchange or its employees should have to get insurance producer or consultant licenses.

A group of people who have been picked by the NAIC to represent consumer interests in NAIC proceedings briefly mention producers in a comment letter on the model.

“The Exchange structure should provide for a strong consumer and employer voice in governance, but should exclude those with conflicts of interests because they have a direct financial stake in the health system — such as organizations and individuals representing hospitals, physicians, insurers and producers,” the consumer reps say. “State officials, such as the insurance regulator and the Medicaid director should have a formal role in the governance of a successful Exchange.”