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CMS Issues Health Insurance Exchange Proposed Rules

John Commins, for HealthLeaders Media, June 17, 2013

The rule also proposes establishing standards for Department of Health and Human Services-approved enrollee satisfaction survey vendors, standards for the handling of consumer complaints, and other provisions to ensure smooth operation of the marketplaces, protect consumers, and give flexibility to states, CMS said in a media release.

A marketplace consumer call center will soon offer program information and then help consumers with open enrollment and plan selection on Oct. 1. CMS will also begin consumer assistance training this summer to help consumers find the right plan.

CMS issued an outline of the proposed rule that highlights key policies:

State-operated premium stabilization programs
HHS proposes standards for the oversight of states that operate either risk adjustment or reinsurance programs. The rule would require that states keep an accurate accounting for the programs, submit to HHS and make public reports on operations, and take other steps to ensure the soundness and transparency of the programs.

Advance payments of the premium tax credit and cost-sharing reductions
HHS proposes timeframes for refunds to eligible enrollees and providers, as applicable, when an issuer incorrectly applies the advance payment of the premium tax credit or cost-sharing reductions, or incorrectly assigns an individual to a plan variation (or a standard plan without cost-sharing reductions).

HHS also proposes general standards necessary for the oversight of these payments, including the maintenance of records, annual reporting of summary level statistics, and audits.

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