With Oct. 1, 2013 looming, states eager for answers on insurance exchanges

Krista Drobac admits the recent release of a CMS Q&A document outlining specifics of the Health Insurance Exchange program took her by surprise.

“It is unusual for HHS to release their thinking on a final rule before it becomes official,” said Drobac, director of the National Governors Association’s Health Division’s Center for Best Practices. “This is big news for the states because HHS is finally answering questions people have been asking for months.”

Drobac believes the CMS document, released Nov. 29, is in direct response to a letter the association wrote to the agency just weeks before, in early November. The NGA letter, written by Chair Terry Brandstad (Iowa governor) and Vice-Chair Pat Quinn (Illinois governor), asked HHS Secretary Kathleen Sebelius for more details about the HIX program so that states could effectively proceed with implementation.

“States can only make suitable decisions if provided with complete and timely information regarding the structure of a state-federal partnership, essential health benefits and design of a federal exchange,” Branstad and Quinn wrote in the letter. “In addition, governors and legislators are still weighing the various exchange models and cannot fully consider their options without knowing the costs associated with a state-based exchange versus a partnership or federal model.”

Drobac says the Q&A document “responds to the uncertainty expressed by the states” and that with the government’s action, “we’re having an impact – they are listening.”

For instance, on the question of how multi-state plans should adhere to state-based insurance standards and exchange-specific qualified health plan certification standards, the agency offers the following explanation: “While the proposed rule on Establishment of Exchange and Qualified Health Plans deems OPM (Office of Personnel Management)-approved multi-state plans as certified by an Exchange, we recognize States’ concerns about the need to apply State insurance requirements and State-specific certification standards to multi-State plans. We also note that Section 1324 requires a level playing field in connection with certain State and Federal legal requirements for health plans. We seek to ensure that Section 1324 does not disrupt existing markets both inside and outside the Exchanges in the States.”

Upon news of the Q&A document, NGA and state officials were busy scouring it for details pertinent to their efforts. Prior to its release, state officials such as Linda Skinner were wondering aloud about how they could successfully manage an HIX implementation by the Oct. 1, 2013 deadline if details only came out on a piecemeal basis.

“Few organizations would want to take on a project of this size without having answers to so many of their questions before they begin,” said Skinner, director of Health Care Innovation Infrastructure Management for the State of Arizona. “In this project there is no time to wait for all the answers – the number one challenge for project management has been getting enough information to finalize requirements. Every time a state has an unanswered question, it will be trying to fill that gap in order to meet the timelines for development. If answers eventually come out that change what the state decided to do, there may be a change in development. Changes in the scope of work will be deadly to a project with these short timelines.”