HHS submits rules for state insurance exchange benefits

The Department Health and Human Services (HHS) has submitted the proposed final rule on the coverages to be offered by state health insurance exchanges (HIX) to the Office of Management and Budget (OMB). The OMB review process is the last stage before a rule is published.

The proposed rule covers the “essential health benefits” that must be offered and oversight process of the exchanges, as directed by Section 1311 of the Affordable Care Act.

Several other components of the state health exchanges are still forthcoming, including how the state exchanges will define annual limits and pre-existing conditions.

As HHS continues to shape the state health exchange regulations, states have until November 16 to declare in writing what type of state health exchange they will pursue. The deadline for states to submit their blueprints for state exchanges has been extended to December 14. Most states will probably opt for state-federal partnership exchanges, but a dozen states may choose to have state-certified exchanges, Nancy Taylor, JD, co-chair of the Health and FDA Business Practice at Greenberg Traurig, LLC, Washington, D.C., told Long-Term Living in an earlier article. A few states may use a federally-facilitated exchange model, where the state exchange will be operated by the federal government for an initial time period, she said.

Most states have been considering their options for some time, although some had postponed their final decisions until after the election, Taylor added.

Pamela Tabar

Pamela Tabar was editor-in-chief of I Advance Senior Care from 2013-2018. She has worked as a writer and editor for healthcare business media since 1998, including as News Editor of Healthcare Informatics. She has a master’s degree in journalism from Kent State University and a master’s degree in English from the University of York, England.