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Consider how exchange rules might fit with your strategy


A new wave of exchange guidance is about to hit from the Center for Consumer Information and Insurance Oversight

That's because a new wave of exchange guidance is about to hit from the Center for Consumer Information and Insurance Oversight (CCIIO), the arm of the federal Department of Health and Human Services (HHS) charged with overseeing the implementation of the exchange provisions included in the Patient Protection and Affordable Care Act (PPACA).

CCIIO is charged with developing rules for the establishment and operation of exchanges, including both the Small Business Health Options Program (SHOP) Exchange and the American Health Benefit Exchange (AHBE)-through which lower-income individuals will be able to access tax credits and cost-sharing subsidies toward the cost of their coverage. In addition, the regulations delve into the unique roles and responsibilities that arise should the feds go into a state to establish an exchange.

Also on the docket are rules around the offering of qualified health plans through such exchanges, protocols for how plan information is relayed to consumers, and the process for determining subsidy and/or refundable tax credit eligibility.


With all this in mind, here are some of the important questions payers and providers should ask as they review the regulations:

Answering these questions, and the dozens more that will no doubt arise in the course of the regulation-making process.

This column is written for informational purposes only and should not be construed as legal advice.

Cindy Gillespie is managing director for McKenna Long & Aldridge LLP.

Frank Micciche is senior advisor for McKenna Long & Aldridge LLP.

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