The Centers for Medicare & Medicaid Services (CMS) has tentatively given an OK for regulators in Maine, South Dakota and Virginia to certify and oversee qualified health plans (QHPs) that will be sold in the federally-facilitated exchanges in those states.
In letters to Maine and South Dakota's insurance directors and Virginia Gov. Bob McDonnell, Gary Cohen, director of the CMS Center for Consumer Information and Insurance Oversight (CCIIO), said the three states have attested to the requirements for plan management and QHP certification, and can now proceed to preparing for October enrollment.
Trying to have state governments participate in federal or partnership exchanges as much as possible, CMS and CCIIO have been inviting state regulators to perform health plan certification, oversight, rate review and other duties that will otherwise be left to the federal government.
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To meet requirements for QHP certification and plan management, state insurance regulators have to show CMS that they have the legal authority and operational ability to perform a number of functions: collect and analyze plan rates, benefits and cost-sharing; ensure ongoing compliance with the ability to resolve consumer complaints; provide to insurers technical assistance as needed; and manage plan decertification and appeals.
Maine and Virginia, however, may only be taking on the QHP management duties if the federal government funds the work.
In Virginia, a bill awaiting McDonnell's signature would authorize the State Corporation Commission and the Virginia Department of Health to manage QHP certification and regulation, but only if federal funding covers the operational and technology costs.
Likewise in Maine, Insurance Superintendent Eric Cioppa has said the insurance department will only be able to perform the work if it's reimbursed by the federal government.
Cohen told both Cioppa and McDonnell that they can apply for 1311(a) grant funds under the Affordable Care Act to cover the costs. Those and other grants for state exchange planning and partnership or federal exchange operational work are open for application until December 31, 2014.