CCIIO head: federal health care exchanges to be ready to enroll on time

Regulators, agents and consumer advocates were concerned that navigators could assume some agent licensing functions and that is not envisioned by state law. Insurance agents are worried consumer advocates will press navigators into an expanded role. 

New Hampshire Insurance Commissioner Roger Sevigny told Cohen that HHS had not spelled out whether navigators could cross line into licensed activities. Cohen said he doesn’t have the answers yet but noted that navigators are required by statute, and there would be rules out on their scope.

Wisconsin Insurance Commissioner Ted Nickel told Cohen that the state needs guidance on navigators as quickly as possible. Cohen agreed and said he was going back to HHS to talk to folk there Monday morning. Wisconsin is having the federal government come in and build an exchange and just wants to know how to regulate its various aspects and prepare.

Cohen, who has been the deputy insurance commissioner and general counsel at the California Department of Insurance under John Garamendi and Steve Poizner, acknowledged that the PPACA exchange regulations are still coming into focus.

“Yes, we haven’t put out enough for you to know how this will work,” Cohen said. ”I was a state regulator. I am acutely aware there is a state side to this. My firm belief is that the questions will be answered, the policy will be clear, everyone will know what the rules of the road are.”

The job will be to implement the rules, Cohen said.

Originally, HHS had asked states that want to build their own exchanges to submit a detailed exchange construction “blueprint” by November 16. 

Now, HHS Secretary Kathleen Sebelius has written to governors to tell them that all they have to submit by Friday is a “declaration letter” indicating the state is interested in helping to establish its own “state-based exchange” program, according to a copy of the letter posted by StateReforum.org, an affiliate of the National Academy for State Health Policy.

A state can take until December 14 to submit its exchange blueprint, Sebelius said.

A state that wants to work with HHS to develop a “state partnership exchange” — an exchange set up in such a way that a state handles some tasks and HHS handles others — can submit declaration letters and blueprint applications on a rolling basis up until Feb. 15, 2013, Sebelius said.

Individual consumers and small employers are supposed to be able to use new tax subsidies to buy plans that sell a standardized “essential health benefits” (EHB) package through new PPACA exchanges.

A “qualified health plan” (QHP) that sells coverage through an exchange can offer up to four “metal levels” of coverage, ranging from a bronze-level plan, which would cover 60 percent of the actuarial value of the EHB package, to a platinum-level plan, which would cover 90 percent of the actuarial value of the EHB package.

Individuals are supposed to be able to get “advanced payments” of the new premium tax credits while a calendar year is still in progress, long before they file their income tax forms for that year, so that they can use the “refundable credit” cash to pay for health coverage.

At least in the beginning, only employers with fewer than 50 full-time equivalent (FTE) employees will be able to use SHOP exchanges.