Bill Deal, director of the Idaho Department of Insurance, talks Jan. 5 about Idaho's acceptance of a federal exchange grant. (AP Photo/Matt Cilley)

The final rule of U.S. Health and Human Services (HHS) on affordable insurance exchanges is expected out this month, with reports that it can be as soon as this week or by the end of the month.

The rule is expected to institutionalize how exchanges should implement outreach and education programs and comply with oversight and program integrity requirements. States have great flexibility in the design of exchanges, and in order to ensure a process that is simplified, streamlined, and standardized across the country, the rulemaking notice establishes standards for consumer protections for all exchanges, according to HHS.

It cannot be soon enough for regulators here who have said there is a lot of work ahead of them, and that they want clarity from HHS as soon as they can get it, for the sake of the states.

“Soon” was a watchword here at here at the Spring National Meeting in New Orleans with respect to hearing from the HHS Centers for Medicare and Medicaid Services (CMS) on a number of matters of guidance or rules.

“I don’t think we are prepared for the tsunami that is headed our way,” said Louisiana Insurance Commissioner Jim Donelon, the NAIC vice president and the commissioner leading the NAIC Plenary meeting Tuesday.

The Plenary is the body that includes all voting members of the NAIC.

Donelon was referring to a timeline given by America’s Health Insurance Plans (AHIP) in a private briefing to commissioners Friday night here. Exchanges are expected by HHS to be up and running by Jan. 1, 2014.

A spokesman for the Center for Consumer Information and Insurance Oversight (CCIIO), which is charged with helping implement many provisions of the Affordable Care Act, didn’t comment although staff here at the NAIC meeting in New Orleans told the NAIC that the report was coming out as soon.

Health Insurance and Managed Care Committee Chair Sandy Praeger told the Plenary the rule will be out by the end of the month, although commissioners were saying earlier the rule would come out this week.

Praeger said here to National Underwriter Monday that states are waiting for the final rule so they can move forward definitively on preparing exchanges, especially the information technology elements, and do it in time for implementation. She suggested urgency in getting the exchanges done, lest the federal partnerships come in and take the place of the state exchanges. 

The rule would build on a July 11, 2011, notice of proposed rulemaking (NPRM) outlining a framework that states could use to build Affordable Insurance Exchanges — state-based markets that individuals and small businesses could to buy private health insurance.

In other health news, Oklahoma Insurance Commissioner John D. Doak’s proposed resolution on religious freedom in health care, a protest against the HHS final rule and accommodation on contraception coverage requirements, failed before the Plenary today when it did not attract a sponsor. Doak quoted Ronald Reagan to make his case, and he said that all states have employers who are “wanting to protect our religious liberties in health care.”

Doak told attendees at the Plenary that he was asked beforehand to withdraw the resolution, but felt he needed to go forward with it.