Proposed rules don't give states enough time to establish health information exchanges and limit their flexibility and control over operating them, said roughly 30 organizations, including state governments, business groups, lobbyists, and special interest groups, in public comments.
The Department of Health and Human Services proposed three rules to govern the creation and operation of state-based health insurance exchanges, as well as the employer standards and Medicaid eligibility related to them.
The framework for HIX was established in the Patient Protection and Affordable Care Act of 2010 and is scheduled to take effect in 2014. According to HHS, more than 25 states have launched efforts to create exchanges.
Here's a sampling of the comments posted in response to the proposed rules on regulations.gov:
America's Health Insurance Plans, the health plan industry's trade organization, filed 30 pages of comments. It's no surprise that AHIP supports putting insurers and insurance experts on HIX governance boards. The group recommends the Centers for Medicare & Medicaid Services, which will oversee the program, develop a common definition of quality improvement standards for all exchanges but with the flexibility to meet the needs of the local enrolled population. To balance affordability and provider access, AHIP warned CMS against taking additional steps to define network adequacy and sufficient essential community providers and instead adopt existing state law requirements pertaining to network adequacy.
The Association for Community Affiliated Plans, which represents safety net health plans with more than eight million enrollees in 28 states, recommended that states "be required to assess income on an annual basis to avoid situations where an individual is inappropriately determined ineligible for both Medicaid and HIX coverage." It also wants CMS to reduce any barriers that would limit the ability of safety net health plans to participate in HIX. ACAP said CMS should allow for a five-year transitional period for the health plans to build required reserves, a three-year transitional period to allow unaccredited plans to obtain the required accreditation, and two years to allow Medicaid-focused health plans to gain licensure.