On September 19, 2013, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule regarding financial integrity and oversight standards with respect to Affordable Care Act Insurance Exchanges.
As of January 1, 2014, Affordable Insurance Exchanges (“Exchanges”) can make available private health insurance coverage for qualified individuals and employers. This proposed rule outlines standards for financial integrity and oversight for Exchanges, as well as for issuers in Federally-facilitated Exchanges (FFEs), and States. The rule also addresses the risk adjustment and transitional reinsurance programs. The proposed rule details accounting requirements for State-operated reinsurance and risk adjustment programs, and includes requirements relating to summary reports and external audits for such programs. Additionally, the proposed rule offers standards for special enrollment periods, survey vendors, issuer participation in an FFE, and States’ operations of a Small Business Health Options Program (SHOP). CMS notes that, while the proposed rule would become effective in January 2014, CMS does not believe affected parties will have difficulty complying with the new provisions because most of the proposed requirements are based on existing standards within the private market, and were previously proposed and discussed in regulatory guidance.