Builders of individual Patient Protection and Affordable Care Act (PPACA) health insurance exchanges are having trouble setting up navigator and in-person assister programs on schedule.
Builders of the PPACA small-group exchanges — the Small Business Health Options Program (SHOP) exchanges — reported in May that they had fallen behind on 44 percent of the key activities that were supposed to be completed in May.
John Dicken, a director at the U.S. Government Accountability Office (GAO director), included those findings in reports on PPACA exchange implementation progress prepared for congressional Republicans.
Dicken made no recommendations and came to no firm conclusions about whether the individual exchanges or SHOP exchanges will open on time.
On the individual side, for example, the states that are setting up their own exchanges and the government workers that are setting up the “federally facilitated exchanges” (FFEs) that will be wholly or partly run by the U.S. Department of Health and Human Services (HHS) have made “much progress” at creating a regulatory framework for the exchanges and develop, test and implement a central HHS data hub that is supposed to handle program eligibility determination processes.
But the development of the program “has been a complex undertaking, involving the coordinated actions of multiple federal, state, and private stakeholders, and the creation of an information system to support connectivity and near real-time data sharing between health insurance exchanges and multiple federal and state agencies,” Dicken said.
“Certain factors, such as the still-unknown and evolving scope of the exchange activities CMS will be required to perform in each state, and the large numbers of activities remaining to be performed—some close to the start of enrollment—suggest a potential for implementation challenges going forward,” Dicken said.
Similarly, on the SHOP side, state agencies and the Centers for Medicare & Medicaid Services (CMS), the HHS arm in charge of exchange construction, have made much progress, but they still face implementation challenges, Dicken said.
“Whether CMS’s contingency planning will assure the timely and smooth implementation of the exchanges by October 2013 cannot yet be determined,” Dicken concluded in each report.