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CCIIO: State-run exchanges can send individuals to feds

By Allison Bell

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The U.S. Department of Health and Human Services (HHS) wants to let Utah keep running its health insurance exchange (HIX) for small employers and have HHS provide exchange services for individuals.

Gary Cohen, the director of the Center for Consumer Information and Insurance Oversight (CCIIO), has described the department’s views on the Utah exchange system in a letter to Utah Gov. Gary Herbert, R.

CCIIO — pronounced “Sih-Sigh-Oh” — is an arm of the Centers for Medicare & Medicaid Services (CMS), which is, in turn, an arm of HHS.

CCIIO runs HHS efforts to set up the new Patient Protection and Affordable Care Act (PPACA) health insurance exchange system.

When members of Congress were developing the original PPACA exchange proposals, they often emphasized that they were basing the proposals in part on Utah’s efforts to develop the Avenue H exchange system for small employers.

HHS approved a Utah exchange blueprint in January, and now it wants to grant Utah’s request to continue to run Avenue H as a PPACA Small Business Health Options Program (SHOP) exchange while having HHS set up a federal exchange for individuals, Cohen said.

CMS intends to propose a change in regulations to make the SHOP-individual market split possible, Cohen said.

Utah would provide Navigators, or ombudsmen, for the SHOP exchange, and CMS would provide Navigators for the individual market, Cohen said.

Utah regulators would certify health plans for the SHOP exchange and help certify plans for the individual market, but CMS would have the legal responsibility for certifying the individual market plans, Cohen said.

After a year, Utah could decide whether it wants to keep the SHOP-individual exchange split or take another approach, Cohen said.

“Under the amended rules, similarly situated states would have the same opportunities as Utah,” Cohen said.

CCIIO has given another, more general version of its views on states running SHOP-only exchange programs in a batch of answers to frequently asked questions. 

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