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HIX Final Rule Released

Margaret Dick Tocknell, for HealthLeaders Media, March 13, 2012

The final rule released Monday by the Department of Health and Human Services to guide the development by states of health insurance exchanges (HIX) can be summed up in a single word: flexibility.

States had argued that HHS was taking on too much of a role in HIX development. The final rule provides states with more options in terms of the operation of the HIX, health plan participation, and member eligibility.

States will be able to:

  • Decide if the HIX will be operated by a non-profit organization established by the state, as an independent public agency, or as part of an existing state agency. A state can also choose to partner with other states on a regional HIX or it can operate multiple HIX that cover distinct geographic distinct areas within the state.
  • Set additional standards for health plans offered in an exchange to make sure consumers have access to a variety of providers
  • Decide how a HIX interact with Medicaid agencies when making eligibility determinations—the HIX can conduct complete eligibility determinations for Medicaid or it can make a preliminary assessment and then rely on the state Medicaid agency for a final decision
  • Decide if brokers or agents can sell insurance through the HIX
  • Gain conditional approval of its HIX by Jan. 1, 2013 if the state demonstrates that it has made sufficient progress in the development of the HIX and it will be operationally ready by Oct. 1, 2013. HHS will provide additional details in future guidance.
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