News and Blog

Wednesday, 20 July 2011
HHS Issues Information on State Insurance Exchanges and Rate Review Process

On Monday, July 11, 2011, the Department of Health and Human Services (HHS) issued a press release and several other communication materials on its website to announce the first of what is expected to be numerous proposed rules andregulations regarding Insurance Exchanges – marketplaces established by the Patient Protection and Affordable Care Act (Affordable Care Act) that are designed to give individuals and small businesses more choice when it comes to health coverage. For some individuals, coverage purchased through an Insurance Exchange may be more affordable due to subsidies that may be available based on household income levels.

The proposed rules are entitled Establishment of Exchanges and Qualified Health Plans and Standards Related to Reinsurance, Risks Corridors and Risk Adjustment.

Additionally, on Wednesday, July 6, 2011, HHS issued a fact sheet that announced the results of its review of state health insurance rate review processes to determine whether a state’s process is effective as stipulated in the final rule regarding rate review. HHS determined that 40 states and territories have an effective rate review process for both individual and small group market segments. The Federal government will perform the rate review in the remaining states and territories for the applicable market segment – or partner with the state to perform such a review – until the state or territory develops an effective rate review process.

HHS determined that the State of Tennessee has an effective process in both theindividual and small group market segments. Therefore, the reviewing authority for rates filings in Tennessee will be the state.

Posted on 07/20/2011 3:05 PM by David Widmer