Health Reform Enrollment November 2012 Update (pdf)
The federal government has extended the deadline for states to submit the final Exchange Blueprint (Blueprint). This extension (and any future extensions) provides advocates and other stakeholders with another opportunity to help shape their state’s Exchange. The Blueprint will outline Exchange activities, such as premium tax credit and cost sharing reduction determinations, exemptions, risk adjustment programs, reinsurance programs, plan management, CHIP and Medicaid eligibility assessments and consumer assistance.
For a full description of the Blueprint requirements go to: Draft Blueprint for Approval of Affordable State-based and State Partnership Insurance Exchanges.
Each individual state is allowed to determine how open the Exchange Blueprint review process will be, but states that choose to operate a State-based exchange must include their consumer and stakeholder engagement plan in their Exchange Blueprint. Advocates and other stakeholders should request an opportunity for comment on their state’s Blueprint. But, they should also get creative about finding other ways to provide input -- such as participating in Exchange advisory groups, public board meetings, ad hoc meetings, panel presentations, and opportunities for comment provided by their state Exchange. In addition, after a state submits its Exchange Blueprint, stakeholders should work closely with the Center for Consumer Information & Insurance Oversight (CCIIO) and the Centers for Medicare & Medicaid Services (CMS) to continue to try to shape their state Exchange Blueprint.
EXCHANGE BLUEPRINT
The Blueprint – the Declaration Letter and Exchange Application - explains how the Exchange will meet all operational and legal requirements for 2014. States intending to have a State-based Exchange are required to submit the Declaration and Exchange Application by the new deadline of December 14, 2012. The Department of Health and Human Services (HHS) is accepting Exchange Applications from states that plan to pursue a State Partnership Exchange on a rolling basis with a final deadline of February 15, 2013.
WHAT IS THE DECLARATION LETTER?
The Declaration Letter outlines the type of Exchange model (State-based, State Partnership, Federally-facilitated Exchange) the state has selected and must be signed by the State’s Governor. If a state fails to submit a Declaration letter by December 14, 2012, HHS will assume that the State intends to select a Federally-facilitated Exchange and will proceed accordingly.
WHAT TYPE OF INFORMATION IS INCLUDED ON THE EXCHANGE APPLICATION?
The Exchange Application provides an overview of Exchange activities, such as:
| • Legal Authority | • Eligibility & Enrollment |
| • Technology | • Plan Management |
| • SHOP | • Risk Adjustment & Reinsurance |
| • Organizational & Human Resources | • Privacy & Security |
| • Finance & Accounting | • Contracting & Outsourcing |
| • Consumer & Stakeholder Engagement & Support | • Oversight & Monitoring & Reporting |
HHS must approve or conditionally approve the state Blueprints by January 1, 2013. If a State can show that it can “perform all required Exchange activities,” its Blueprint will be approved by HHS. Conditional approval will be provided to states that do not meet the requirements for approval, if they can show they are making “significant progress” in meeting those requirements and will be ready for Open Enrollment on October 1, 2013. If a state receives conditional approval, HHS will work with the state to ensure that its Exchange will be ready for operation by the initial enrollment period.
Stakeholders and advocates interested in learning more about their State Exchange Blueprint process should check out the State Refor(u)m chart,
