The Centers for Medicare & Medicaid Services is about to publish final regulations that will set rules for Web brokers that help consumers use the public exchanges.

The new rules also will let traditional agents and brokers use the Web brokers’ sites to sign consumers up for public exchange coverage.

Another provision will let states that are not able to set up individual exchange programs in 2014 seek federal permission to set up Small Business Health Option Program exchanges that serve only small groups.

Still other sections of the final regulations for cover topics such as whether health insurance premiums are fair; standards for the new risk-management programs designed to keep commercial health insurers from getting wiped out by floods of sick consumers now eligible for care through the Patient Protection and Affordable Care Act (PACCA); and eligibility appeals.

CMS, an arm of the U.S. Department of Health and Human Services, is getting ready to publish the final regulations in the Federal Register Friday.

CMS developed the regulations, which are based on a draft released in June, to implement many different sections of PPACA.

In the section on Web brokers, CMS notes that states that are running their own state-based exchanges can choose whether or not to work with Web brokers.

In states with CMS-run exchanges, Web brokers can open up their sites to outside agents and brokers, CMS says.

“The Web-broker must cooperate with HHS in taking compliance actions against a noncompliant agent or broker, including facilitating a shut-down of any connection to HHS systems while privacy and security incidents and breaches are investigated,” CMS said.

In a discussion about states that want to set up SHOP-only exchange programs, CMS acknowledged that some commenters argued that individual-SHOP programs are better.

CMS will compromise by limiting use of the SHOP-only exchange option only to states that are unable to set up an individual-SHOP program, officials said.

CMS already has given Utah and New Mexico permission to set up SHOP-only exchanges. Both of those states had CMS permission to set up both an individual exchange and a SHOP exchange.

Mississippi, a state that failed to get permission to set up an individual-SHOP exchange, now is trying to set up a SHOP-only program.

Elsewhere in the final regulations, CMS:

  • Said it will come up with a list of payment methods an exchange plan issuer must accept later, but that any requirements will apply to the first customer payment for coverage as well as later payments;
  • Refused to require SHOP exchanges to accept applications on paper or over the telephone. Small businesses can still apply for coverage through in-person meetings with agents, brokers or navigators;
  • Refused to accept recommendations that it let “navigators,” or independent exchange program ombudsmen, act as “SHOP application filers.”
  • Noted that the effective date of the regulations is Oct. 1, but argued that any market participants should be ready to adopt the regulations, because the information has already been available in other public documents.

See also: