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July 11, 2011 at 08:00 PM
The U.S. Department of Health and Human Services (HHS) has posted draft health insurance regulations that would let an exchange work with agents and brokers, provide producer listings on its website, and include producers in Navigator programs.
HHS officials have given states a chance to open their health insurance exchange programs to producers in a proposed rule implementing exchange establishment and qualified health plan provisions of the Patient Protection and Affordable Care Act of 2010 (PPACA).
Health insurance producers have been saying they were afraid that HHS and state officials 
would try to shut them out of participating in the new, exchange-based health insurance distribution system by, for example, preventing them from acting as “Navigators,” or guides to the new system.
But HHS says a state can decide for itself what role it wants producers to play.
Section 1312(e) of PPACA “gives states the option to permit agents or brokers to assist individuals enrolling in [qualified health plans (QHPs)]through the exchange,” officials say in a preamble to the proposed rule. “This includes allowing agents and brokers to enroll qualified individuals, qualified employers, or qualified employees in QHPs and to assist individuals with applications for advance payments of the premium tax credit and cost-sharing reductions.”
HHS also has released another proposed rule dealing with exchange risk adjustment provisions.
Health Insurance Exchanges
If PPACA takes effect as written and works as supporters hope, it will create a system of state-supervised health insurance distribution exchanges that will help individuals and small groups buy health coverage using a new system of subsidies starting in 2014.
The Internal Revenue Service will provide the subsidies through a new system of tax credits.
PPACA also is supposed to create a new system of Navigators, who are supposed to be independent from health insurers, to help individuals buy coverage.
States will provide exchange services for small employers through the Small Business Health Options Program (SHOP).
A state can let several exchanges operate within its borders, set up one exchange, join a multi-state exchange consortium, or let the federal government provide exchange services for its residents.
The District of Columbia, 49 states and 4 territories have accepted preliminary exchange planning grants, and more than half of the jurisdictions have taken additional steps toward setting up exchange programs, HHS officials say. Only Alaska has taken no steps at all toward looking at the possibility of participating in the exchange program.
The Proposed Rules
HHS wants to give states a great deal of flexibility in exchange design and administration, officials say.
