Deadline For Filing Blueprint For Approval Of Exchanges Extended

By Larry Grudzien
Attorney At Law

On November 9, the Department of Health and Human Services (HHS) extended the deadline for submission of the State-based Exchange Blueprint application from its original date of Nov. 16 to Dec. 14, 2012. The deadline for submission of the Declaration Letter for a State-based Exchange will remain Friday, Nov. 16, 2012. HHS will approve or conditionally approve a State-based Exchange for 2014 according to the statutory deadline of Jan. 1, 2013.  Please find a copy of the announcement below:
 

Q1: When does a state have to tell the Centers for Medicare & Medicaid Services (CMS) that it wants to establish a State-based Exchange for 2014?
 
A1: In order for CMS to provide a state with technical resources and support necessary to meet the January 1, 2013, approval/conditional approval statutory deadline, a state that intends to establish a State-based Exchange must submit a Declaration Letter by Friday, November 16.
 

Q2: If a state wants to establish a State-based Exchange, when is the Blueprint Application due? What about the Declaration Letter?
 
A2: In order to provide states with more time to create a comprehensive Blueprint Application that is fully representative of their work, the Department of Health and Human Services (HHS) extended the deadline for State-based Exchange Blueprint Applications to Friday, December 14, 2012. Declaration Letters for State-based Exchanges remain due on Friday, November 16, 2012. CMS encourages states to begin working with the Center for Consumer Information and Insurance Oversight (CCIIO) on their Blueprint Applications as early as possible in order to identify any issues early and to receive feedback on their Blueprint Applications. A state may also submit its Blueprint Application prior to the deadline.
 

Q3: My state is ready to declare that it intends to establish a State-based Exchange, but still needs more time to determine whether it will establish and operate Risk Adjustment and Reinsurance programs. What should my state do?
 
A3: If a state knows what Exchange Model it intends to pursue, and who is the appropriate designee to execute the Declaration Letter, CMS encourages each state to submit a Declaration Letter on or before November 16, 2012. If a state has concerns about whether its decisions will be made by mid-November 2012, please talk to your CCIIO State Officer about your options. An interested state must commit to running either program in their Blueprint Application (Sections 5.1 and 5.2) that is due December 14, 2012. Please keep in mind that only a State that has elected to operate a State-based Exchange (not a State that has elected to participate in a State Partnership Exchange) can operate a risk adjustment program, or the State-based Exchange can defer its operation to the federal government. A state may elect to establish and operate a reinsurance program regardless of the Exchange model selected.
 

Q4: My state is not sure it wants to establish and operate a State-based Exchange, but we want to be involved in our Exchange. What options do we have?
 
A4: CMS established the option for states to pursue a State Partnership Exchange, where a state can work with CMS and elect to operate the Plan Management functions, Consumer Assistance functions, or both within the Federally-facilitated Exchange established for your state. States have until Friday, February 15, 2013, to submit a Declaration Letter and Blueprint Application declaring what partnership role they would like to have in operating the Exchange in their states. Ultimately, CMS wants as many states involved in operating Exchange as possible and we encourage states to talk with their CCIIO State Officer to discuss the partnership options.
 

Q5: If a state is ready to submit its Blueprint Application, does it have to wait until December 14, 2012?
 
A5: No, a State may submit its Blueprint Application for State-based Exchanges any time before December 14, 2012, and for State-Partnership Exchanges any time before February 15, 2013.
 

Q6: If a state applies to establish a State-based Exchange and later decides it would rather be a State Partnership Exchange in 2014, can it change its mind?
 
A6: Yes, if a state applies to establish a State-based Exchange for plan year 2014 and later decides it is more prepared to operate as a State Partner, it can move into a State Partnership model. States should contact their CCIIO State Officer as early as possible to begin the transition.
 

Q7: If a state has a State Partnership Exchange in 2014, can it move to a State-based Exchange in 2015?
 
A7: Yes. If a state decides to be a State-based Exchange for plan year 2015, it will have to submit its State-based Exchange Declaration Letter and Blueprint Application, completing all the relevant additional sections. For the 2015 plan year, the Declaration Letter and Blueprint Application are due November 18, 2013, and December 16, 2013, respectively. It can also establish a State-based Exchange in subsequent years.rom 2014 through 2006, each state that operates an Insurance Exchange is required to establish a temporary reinsurance program for the individual market, to which health insurers and group health plans are required to contribute, as provided in PPACA, Pub. L. No. 111-148, Section 1341 (2010), as amended by PPACA, Pub. L. No. 111-148, Section 10104(r) (2010).  This program shifts the risk of covering high expenses from the primary insurer to a reinsurer.  

If you have any comments or questions regarding any of above information, please do not hesitate to call (708) 717-9638 or e-mail larry@larrygrudzien.com.