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CMS Issues Health Insurance Exchange Proposed Rules

John Commins, for HealthLeaders Media, June 17, 2013

Most of the proposal focuses on program integrity for state marketplaces and insurance companies offering coverage in the federally facilitated exchanges. The rule intends to safeguard federal money and consumers.

The Centers for Medicare and Medicaid Services has unveiled its proposed rules governing the operation of health insurance exchanges [PDF] which aim to facilitate and regulate the sale of private coverage to millions of people beginning Jan. 1, 2014, under the Patient Protection and Affordable Care Act.

CMS released the 253-page proposal on Friday afternoon with little fanfare or notice. The agency said most of the proposal focuses on program integrity for state marketplaces and insurance companies offering coverage in the federally facilitated exchanges, advance payments of the premium tax credit and cost-sharing reductions, and premium stabilization programs.

The proposed rule intends to safeguard federal money and consumers by ensuring that insurance companies and marketplaces actually provide consumers with access to affordable health insurance with reasonable benefits. Consumers in every state will be able to buy insurance from qualified health plans directly through these marketplaces and may be eligible for tax credits to lower the cost of their health insurance.  

A public comment period for the proposed rule extends for 90 days.

"In just a few months, consumers across the country will have access to a new Marketplace in their state where they can easily shop for health insurance that meets their needs and the needs of their families," CMS Administrator Marilyn Tavenner said in prepared remarks. "The release of these guidelines signals that we're ready to build on our ongoing efforts and ensure that the new systems are fiscally sound."

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