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HHS Releases Final Rule on Affordable Insurance Exchanges

The Department of Health and Human Services (HHS) has released a Final Rule (644 pages) to implement Affordable Insurance Exchanges (Exchanges), which must become operational by January 1, 2014.  Exchanges will provide marketplaces where individuals and small employers can compare private health insurance options (e.g. based on price and quality).  The Final Rule combines proposed rules issued on July 15, 2011 and August 17, 2011 relating to Exchange establishment and eligibility.

As described by HHS, the Final Rule includes:

  1. Minimum standards that states must satisfy if they elect to establish an Exchange (e.g. standards for individual and employer eligibility in an Exchange);
  2. Minimum standards that health insurance issuers must satisfy to participate in an Exchange and offer qualified health plans; and
  3. Standards that employers must satisfy to participate in the Small Business Health Options Program.

A number of the provisions in the Final Rule are interim rules, open to public comment.  HHS is accepting comments on interim provisions relating to the following, among others:

  1. The ability of agents and brokers to assist individuals in applying for advance payment of the premium tax credit and cost-sharing reductions for qualified health plans;
  2. Options for conducting eligibility determination;
  3. Eligibility standards for cost-sharing reductions;
  4. Timeliness standards for Exchange eligibility determinations;
  5. Verification for applicants with special circumstances; and
  6. Agreements between agencies administering insurance affordability programs.
©2020 von Briesen & Roper, s.cNational Law Review, Volume II, Number 75


About this Author

von Briesen & Roper’s Health Law Section provides comprehensive legal services to the health care industry nationwide as both general counsel and special project counsel. Our clients include integrated delivery systems, academic medical centers, community hospitals, Catholic-sponsored hospitals, rural and critical access hospitals, imaging centers, physicians and multi-specialty clinics, specialty hospitals, ancillary suppliers, home health agencies, nursing homes, hospices, assisted living facilities, mental health and AODA facilities, DME suppliers, laboratories,...