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Officials involved in health reform efforts from seven states are pushing HHS to provide detailed information on the specifications of a federally-run exchange, including governance, consumer functions, eligibility and financial management, according to a Jan. 11 letter obtained by Inside Health Policy. The officials want HHS to hand over the information by June so that states considering deferring some or all of their exchange functions can understand how those processes would work in the context of a state exchange, and because HHS is requiring states to submit detailed information for state exchange certification.

“It seems reasonable that HHS be able to provide the same type of information to states as the states would be required to provide to HHS,” the letter states.

States and other stakeholders have frequently said that they want more information about the federal exchange that HHS would run in states that do not set up their own, and the scarcity of details surrounding its basic components is generating concern.

The letter was sent to Center for Consumer Information and Insurance Oversight leadership on Jan. 11 and was signed by: Norman Thurston, Utah’s health reform implementation coordinator; Tennessee Medicaid Director Darin Gordon; Tennessee Insurance Exchange Planning Initiative Director Brian Haile; Kentucky Department of Insurance Director William Nold; Katrin Teel, a senior health policy adviser in Maine’s governor’s office; New Mexico Office of Health Reform Director Dan Derksen; Molly Huffstetler, deputy director of the Virginia Health Reform Initiative; and North Dakota Insurance Commissioner Adam Hamm.

An administration official on Wednesday (Jan. 18), following the release of a White House report documenting several states’ progress on establishing exchanges, sought to ensure that there is money available for HHS to set up and operate a federally-facilitated exchange. In that report, the White House also said that additional guidance on the federal exchange would be forthcoming.

All of the states but Kentucky have Republican governors, and the states run the gamut in terms of where they are with their respective exchanges -- Utah created an exchange before the health law’s passage, but Tennessee and Kentucky have not yet introduced any exchange legislation.

“We wish to emphasize to our partners in HHS that it is equally important for states to understand the nature of the federal alternative that will be facilitated if they do not seek certification,” the letter states.

Broadly, the information sought about the federal exchange mirrors that included in the draft exchange certification application for states that the administration has released. States must complete that application if they seek approval for their exchange from HHS.

The letter’s signers ask that HHS provide them the information no later than June 1 so they can properly assess the direction they should take.

HHS must determine by Jan. 1, 2013 whether a state will have a fully operational exchange by the start of 2014, with the administration saying in the proposed exchange establishment rule that it believes “fully operational” means a state is capable of beginning operations by Oct. 1, 2013 to support the first open enrollment period. HHS has also proposed allowing states to receive conditional approval if they cannot demonstrate readiness at the beginning of next year but it seems like their exchange will be operational by the initial open enrollment period. Sources have said details on that designation have been lacking (see related story).

In the letter, they write that HHS should provide for several planning and operational areas a detailed description of proposed federal exchanges that includes at least “a comprehensive implementation plan along with business process models, key milestones, high-level timelines, and detailed progress reports showing current achievement of the milestones.”

In November, CMS issued the proposed exchange certification application that states would fill out. Comments were due earlier this month. 

Source:Inside Health Policy