Monday, September 26, 2011

Health Reform Exchange Partnership Opportunities Expanded

The Department of Health and Human Services (HHS) has provided some additional information to states on partnership opportunities for establishing American Health Benefit Exchanges.

According to the HHS, "The Partnership model describes Exchanges where both HHS and a state work together to operate different functions of the Exchange. The goal of the Partnership is to take advantage of the state's expertise and knowledge of their insurance markets to support a seamless consumer experience. States may use Exchange grant funding to support the functions they choose to operate under the Partnership that are related to establishing the Exchange."

The HHS noted that "some states have expressed a preference for a flexible state partnership model combining state-designed and operated business functions with federally-designed and operated business functions." Examples of such shared business functions might include eligibility and enrollment, financial management, and health plan management systems and services. States have the option to operate an exclusively state-based Exchange.

Under the proposed partnership model, states may choose one of the following options:

State plan management. If electing to operate the plan management function, states will help tailor health plan choices for their state's Exchange. This option builds on the existing strengths and expertise of states. Plan management functions include the collection and analysis of plan information, plan monitoring and oversight, and data collection and analysis-all functions that states have extensive experience performing in the current marketplace. The HHS will coordinate with the state regarding plan oversight, including consumer complaints and issues with enrollment reconciliation. Where appropriate, the HHS will help to ensure that Exchanges meet all of the required standards so consumers have access to a range of high quality plan options.

State consumer assistance. If electing the consumer assistance functions, a state would oversee in-person consumer assistance, manage the Navigator program (which will help provide direct assistance helping people sign up for insurance), and conduct outreach and education-all functions that build on existing state relationships. Other consumer assistance functions which can be more centralized-including call center operations, managing the consumer website, and written correspondence with consumers to support eligibility and enrollment-would be operated by the HHS.

Both plan management and consumer assistance. If electing this option, states would perform both of these functions.


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