Breaking: Insurance Exchange Rules Proposed By HHS, Treasury


The cornerstone of last year’s health care reform law was the establishment of Affordable Insurance Exchanges — entities run by either state agencies or non-profit organizations where individuals could purchase health insurance or through which small businesses could provide coverage for their employees.  The Departments of Health and Human Services (HHS), the Centers for Medicare and Medicaid Services (CMS)  and the Treasury have released three Proposed rules to implement these exchanges.

The exchanges will be established so that individuals and businesses can start using them to shop for coverage starting in 2014.

The HHS rule would implement rules regarding eligibility determinations for participation in an insurance exchange as well as standards for small employers.

The CMS rule would replace existing Medicaid eligibility rules with simpler income-based rules and systems for processing applications for most Medicaid applicants.

The Treasury rule would implement a health insurance premium tax credit for individuals and families with incomes between 100% and 400% of the federal poverty level.

All three rules will be published in the Federal Register on August 17.

According to HHS, the three rules will help establish a seamless system where individuals can figure out if they qualify for insurance premiums that would help them purchase insurance through an exchange or if they qualify for Medicaid. In effect, the exchanges would be one-stop shopping for individuals and businesses, and are designed to minimize a state’s administrative burden.

In addition, HHS awarded $185 million to 13 states and the District of Columbia to assist them in building exchanges.