Health exchange regulations unveiled today made clear that consumers in all states will have access to the new system effective Jan. 1, 2014, whether it be through a federal exchange or a state exchange.
The final rule says states will have flexibility in transitioning to the new system, but said that federal officials have interpreted the Patient Protection and Affordable Care Act to say that the system will be launched as of Jan. 1, 2014.
“These policies give states the flexibility they need to design an exchange that works for them,” said HHS Secretary Kathleen Sebelius.
She said that these new marketplaces would offer Americans “one-stop shopping for health insurance,” where insurers would compete for their business.
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“More competition will drive down costs and exchanges will give individuals and small businesses the same purchasing power big businesses have today,” she said.
The final rule also empowers states to determine a role for agents and brokers, including the use of on-line brokers. It also removes processing of appeals from minimum exchange functions.
In comments included in the final rule, HHS also clarified that in writing the regulation, HHS tried to ensure that agents and brokers will play a significant role in providing advice to consumers who participate in the exchanges.
Regarding the Navigator program, which insurance agents and brokers opposed during drafting of the bill out of concern that only volunteers and not professionals be used to provide aid, the final rule said that a “Navigator must meet any licensing, certification or other standards prescribed by the State or Exchange, as appropriate, and may not have a conflict of interest during the term as Navigator.”
The final rule says that health insurance issuers are prohibited from serving as Navigators and that Navigators must not receive any compensation from any health insurance issuer in connection with the enrollment of any qualified individuals or qualified employees in a QHP.
The final rule also gives states the flexibility to run an exchange through an existing state agency or through a nonprofit entity established by the state.
States under the regulation will also have the authority to open its exchange to all insurers and health plans, or it can limit the number of health plans available to consumers through the exchange.
The rule will also allow larger employers to participate.
Under the final rule, in 2014 and 2015, each exchange will be open to companies with either 1 to 50 or 1 to 100 employees. As of 2016, all exchanges will be open to businesses with 1 to 100 workers. Starting in 2017, states can let in companies with more than 100 employees.
The final rule also provides that states must levy user fees to insurance companies, not consumers.
The rule also allows states to join up to establish regional exchanges,