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3 Groups Payers Will Watch Closely in 2013

Jacqueline Fellows, for HealthLeaders Media, January 2, 2013

2. Centers for Medicare & Medicaid Services
Every healthcare entity has its finger on the pulse of CMS, but in 2013, payers will be looking at the agency even more closely because health insurance exchanges have to be up and running by October.

Late in 2012, CMS issued three significant proposed rules guiding exchanges: essential health benefits, health insurance market and rate review, group wellness. The comment period is closed now despite several groups, including some in Congress, lobbying for an extension.

Health insurers are now waiting for the final rule to be published to see if comments from AHIP and other groups affected any change in the proposals. At issue is the amount payers would have to increase premiums to cover the cost of additional benefits without cost-sharing.

And while payers haven't been silent on the health insurance exchanges, they haven't visibly stepped up as actual participants. Currently, only Aetna has said it plans to participate in 15 health insurance exchanges.

AHIP's stance on exchanges has favored those that are run by states. As of the 2012 deadline for states to declare whether they would enter into a state- or federally run, or partnership exchange, 18 states plus the District of Columbia committed to a state-run health insurance exchange.

CMS is approving the states to move forward with plans fairly quickly. It has until January 31 to tell states if the plans submitted are approved. The next health insurance exchange deadline is February 15. That's the deadline for states to declare whether they intend to enter into a partnership with the federal government on running a health insurance exchange.

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