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Proposed HIX Rules Would Alter PPACA

Christopher Cheney, for HealthLeaders Media, March 24, 2014

As the inaugural open enrollment period for the new individual health coverage exchanges comes to a close, CMS officials are proposing several changes and additions to the Patient Protection and Affordable Care Act to ensure that HIX hold and grow.

In a 278-page document released this month, federal officials propose to fine-tune, optimize and strengthen the new public health insurance exchanges, including the creation of new laws to protect federal consumer advisers from state interference in performing their duties.

Titled "Patient Protection and Affordable Care Act; Exchange and Insurance Market Standards for 2015 and Beyond, the document also provides details about innovations set to be introduced to the exchanges in 2015 and 2016 such as an Enrollee Satisfaction Survey to gauge beneficiary opinion about their insurance policies and a Marketplace Survey to help "assess consumer experience" with the exchanges. The proposed rule and law changes were prepared by the Centers for Medicare & Medicaid Services.


CMS Announces HIX Changes for 2015


A CMS spokeswoman contacted Thursday said that many of the proposed changes were based on experience from the new public exchanges' initial open enrollment period, which began in October and comes to a close on March 31.

In a clear sign that CMS is beginning to focus on the finer points of exchange operations as opposed to the launch and enrollment efforts that have dominated the agency's attention for more than a year, the "Standards for 2015 and Beyond" document provides guidance for several operational details that had not been previously addressed.

These proposed rule changes cover a wide array of issues, from how health plans should bill beneficiaries for time periods of less than a month as in the case of a birth, to spelling out the difference between the terms "cancellation" and "termination."

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