In our last post, we had discussed about the exchange design and operational model specific guidelines decreed by the HHS.
In this article, we would revisit the primary functionality that a Health Insurance Exchange and SHOP exchange is expected to execute and common benefits that are to be extended to HIX and SHOP exchange consumers through the web-based exchange portals.
Navigator Selection – For the uninformed, exchange navigators would be people responsible for ensuring that exchange participants have a hassle-free and enjoyable health insurance enrollment process. The HHS guideline on navigators suggests possible business areas to which navigators can belong and be hired from – non-profit and community groups, licensed brokers and agents, unions etc. and the employed navigators need to necessarily belong to at least 2 of the 8 specified business areas.
HHS prohibits the state from using federal Exchange implementation grant money to fund the HIX and SHOP exchange navigator program.
Website – The HHS has mandated states to set up simple and easy-to-manouever website that provides detailed information on all health plan related products and services, to consumer’s n easy-to-read and simple manner. The information presented on the website should be understandable to individuals with limited English Language proficiency and any language disabilities.
Premium Payment related Activities – The HHS codifies that although the exchange would facilitate an health insurance purchase and premium payment through its website, the exchange itself would remain a neutral party to the transaction with no payment related participation. Exchanges have an option to allow individuals to pay premiums directly to health payers, collect premiums from consumers and pay them to the payers in bulk, or provide a link between payers and consumers for facilitating payments
Compliance with security protocols – The HHS mandates states to follow and implement all the necessary privacy and security protocols that ensure secure data transfers with no loss in data integrity. HHS has granted all US states the autonomy to incorporate privacy and security standards, in line with the ACA and HIPAA guidelines. States can tailor the protocols and measures as per their business requirements.
Both the SHOP exchanges and the HIX exchanges are scheduled to launch by January 1, 2014. However, before the stipulated deadline, states need to submit their exchange implementation plans at least 30 days prior to the plan approval date of January 1, 2013. If HHS identifies some states with viable exchange plans it may grant these states 'conditional approval', but would continue to monitor the exchange implementation progress for these states. Based on their growth rate and consistency in exchange launch efforts over 2013, the HHS may approve or revoke its approval on the states HIX and SHOP exchange execution plans.
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The October 1 deadline has gone by and the health exchange market is still in a state of turmoil. Not everything has gone as planned and the government has been facing several troubles since the launch day.
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