Among the final rules issued Monday by the Department of Health and Human Services: at least one seat must be reserved for a consumer representative on the governing boards for state health insurance exchanges. Insurers and industry representatives can have as many as half. States cannot allow insurers to determine eligibility for subsidies or Medicaid, but they can assist those applicants in sorting through their health plan options. How the federal government would set up exchanges in states unable or unwilling to establish their own marketplaces is promised in future rules. But states unable to meet the Jan. 1, 2013 deadline for approval of their exchange can receive conditional approval by Health and Human Services if they show they are likely to be fully operational by October 2013 – when exchanges start taking applications.

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