HIX Final Rule Details Payment, Appeals Standards

Cheryl Clark, August 29, 2013

The final rule on health insurance exchanges sets forth standards for agent and broker participation in government-facilitated insurance marketplaces. It also requires qualified health plans that issue exchange products "to accept a variety of payment methods."

Insurance companies and states now have a concrete set of federal rules to govern health insurance exchanges designed to guarantee program integrity, set standards, assure privacy and security, and an appeal process for consumer eligibility.

"The final rule provides for standards that would establish oversight of health insurance issuers," says a fact sheet issued by the Centers for Medicare & Medicaid Services. "This includes HHS (the Department of Health & Human Services) focusing on ensuring compliance with market-lace-related standards while preserving states' traditional role in overseeing the individual and small group insurance market."

A CMS statement said the final rule, released late Wednesday, is basically the same as the proposed rule, which was published June 19.

The exchanges begin Jan. 1, but enrollment begins on Oct. 1, when CMS says most of the provisions of the rule take effect.

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