It would be appropriate to say that 2012 was the Year of Health Insurance Exchanges in the U.S, with the State-Federal Partnership Exchanges and Federally Facilitated Exchanges (FFEs) taking center stage in the new healthcare reform developments. The year 2013 also shows signs of continuing in the same vein as last year. As a result, the hCentive team is diving deeper into the Partnership Exchange model to understand what this model entails and the flexibilities States’ will enjoy under this arrangement.

The combined efforts of the States and the U.S. Department of Health and Human Services (HHS) under the partnership model can help in establishing States’ exchanges and can lay the groundwork for a future transition to completely state-based exchanges. As of January 3, 2013, six U.S. States—Arkansas, Delaware, Illinois, Iowa, North Carolina, and West Virginia—have applied for State-Federal Partnership Exchange and 20 states have received approval for their State-based exchange design. The remaining U.S. states have additional leeway only until February 15, 2013 if they chose to apply for a State-Partnership Exchange.

In August 2012, the Center for Medicare and Medicaid Services released a blueprint for States seeking approval for State-based and State Partnership exchanges. The document contained a detailed layout of the responsibilities that States and the HHS would share in the partnership-based exchange model. The three arrangements that a State can select under the partnership model are:

1.    Plan Management Partnership – States would be responsible for auditing, certifying, de-certifying,  and managing and processes related to Qualified Health Plans (QHPs), providing technical assistance to QHP insurers, ensuring compliance with technology guidelines laid out by the HHS, and implementing quality and testing procedures for business processes in accordance with HHS guidelines.
2.    Consumer Assistance Partnership – States would undertake all responsibilities related to the implementation and management of the navigator system and in-person assistance programs. Responsibilities would include management of the eligibility determination and enrollment processes, such as helping consumers to fill in and submit their applications, determining eligibility for different plans and exchange programs, updating personal details, and comparing and enrolling in a suitable health plan.
3.    Plan Management and Consumer Assistance Partnership – States can take a combined responsibilities approach by managing the reinsurance program and applying for participation in the eligibility determination process for the Medicaid and CHIP program.

HHS would oversee most of the other critical exchange related functions, including the development of data standards for QHP related data collection, reporting, and management processes. The Federal Government would also supervise the administrative and technical procedures—related to the management of exchange website where consumers can search, compare, review, and enroll in plans, as well as management of the toll-free customer care and live-chat centers of the exchange program.

As the final deadline for States to indicate their preference for a partnership-based exchange inches closer, more states are likely to consider switching to the partnership model instead of federal exchanges to enjoy some privileges and control in the running of the federal exchange. However, it is difficult to estimate at this stage whether the remaining states would apply for State-Federal Partnership exchanges or opt for a federally run exchange.

Leave a Reply

You must be logged in to post a comment.