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November 12, 2012
Healthcare reform: Insurance exchange decision deadlines approaching

by Martin Simon, JD, Senior Legal Editor

Update: Kathleen Sebelius, the Secretary of Health and Human Services (HHS), issued a letter on November 15, 2012, announcing an additional extension:

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“Under the law, we are required to certify states’ plans to run their own Exchange in 2014 by January 1, 2013. While receiving a letter of intent now will help us assist states in finalizing their application, a state may submit both a letter of intent and an application to operate its own Exchange by December 14. States may also apply to operate their Exchange in partnership with the federal government by February 15, 2013. And a state may apply at any time to run an Exchange in future years.”

The Affordable Care Act (ACA) requires states to the establish Affordable Insurance Exchanges to provide individuals and small employers with access to affordable insurance coverage beginning January 1, 2014. States have the flexibility to design and operate exchanges that best meet their unique needs while meeting the ACA’s statutory and regulatory standards.

A state that chooses to establish its own exchange or participate in a partnership model, must complete and submit an exchange blueprint that documents how its exchange meets all the legal and operational standards. A state must also demonstrate operational readiness to execute exchange activities as part of its exchange blueprint.

Decisions on to establish a state exchange and blueprint submissions were due to the Department of Health and Human Services (HHS) by November 16, 2012. While states must still inform HHS if they plan to establish an exchange by November 16, HHS has extended the date for submitting blueprints until December 14, 2012. If these deadlines are not met, HHS is to implement a Federally Facilitated Exchange for the state and perform Exchange activities.

In her letter to state governors announcing the blueprint extension, HHS Secretary Kathleen Sebelius stated that HHS will approve or conditionally approve state-based exchanges for 2014 by the statutory deadline of January 1, 2013.

Additionally, for states pursuing a State Partnership Exchange, she said that HHS will accept Declaration Letters and Blueprint Applications and make approval determinations for State Partnership Exchanges on a rolling basis and that the final deadline for both the Declaration Letter and Blueprint Application for State Partnership Exchanges that would be effective for 2014 has been extended to Friday, February 15, 2013.

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