Exchange Legal Authority
Deciding whether or not to establish a state-operated Exchange is the critical first step towards the creation of an Exchange that aligns with state priorities and goals.
*Milestone details:
*Full name: Decide whether to establish an Exchange at the sub-state level, the state level, participate in a multi-state Exchange, or defer to the federal government.
*Relevance to the ACA:
The ACA requires the establishment of health benefits Exchanges. It delegates primary responsibility to the states, but requires the federal government to step in for states that opt out. Provisions relevant to establishing an Exchange include:
§1311 - Establishes the Exchanges and creates grants for states to plan and launch them.
Also creates the option for regional Exchanges and sub-state Exchanges.
§1321 - Gives the Secretary of HHS the power to establish and operate an Exchange in a state that defers or whose Exchange does not meet statutory requirements.
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District of Columbia
Recently introduced legislation in Minnesota would establish the Minnesota Insurance Marketplace, create a governing board and pay for operations with a collection on 3.5% of premiums.
District of Columbia
On January 3, 2012, HHS announced eight states had received conditional approval: seven (CA, HI, ID, NV, NM, VT, UT) were approved for state-based exchanges and AR was approved for a partnership exchange. The letters of approval are attached.
District of Columbia
On December 20, 2012, HHS sent a letter to Gov. Chafee conditionally approving Rhode Island's state-based exchange.
District of Columbia
On December 14, 2012, HHS sent a letter to Gov. Cuomo conditionally approving NY's state-based exchange.
District of Columbia
On December 20, 2012, HHS sent a letter to Gov. Dayton conditionally approving a state-based exchange for Minnesota.
District of Columbia
On December 14, 2012, HHS sent a letter to Gov. Beshear conditionally approving Kentucky's state-based exchange.
District of Columbia
On December 14, 2012, HHS sent a letter to Mayor Gray conditionally approving the District's state-based exchange.
District of Columbia
Utah Governor Gary Herbert wrote to President Obama asking that the President direct HHS to certify the state's exchange as ACA compliant.
District of Columbia
HHS sent a letter to Director Rocky King conditionally approving their application to establish a State-based Exchange.
District of Columbia
HHS sent a letter to Governor Gregoire conditionally approving their application to establish a State-based Exchange.
District of Columbia
HHS sent a letter to Governor O'Malley conditionally approving their application to establish a State-based Exchange.
District of Columbia
HHS sent a letter to Governor Patrick conditionally approving their application to establish a State-based Exchange.
District of Columbia
HHS sent a letter to Governor Malloy conditionally approving their application to establish a State-based Exchange.
District of Columbia
HHS sent a letter to Governor Hickenlooper conditionally approving their application to establish a State-based Exchange.
District of Columbia
On December 6, 2012, NJ Governor Chris Christie vetoed legislation that would establish a state-based exchange. His veto letter indicates that he will not commit to a state exchange until the federal government provides more information.
District of Columbia
On November 15, 2012, HHS Secretary Kathleen Sebelius sent a letter to the RGA allowing an additional month- until December 14, for states to submit their intent to create a state exchange. The deadlines are now December 14, 2012, for a state exchange and February 15, 2013, for a partnership exchange.
District of Columbia
On November 14, 2012, Mississippi Insurance Commissioner Mike Chaney submitted a letter of intent to establish a state-based exchange to HHS.
Virginia
Hi,
Thank you all for this superb resource! The information is invaluable.
I have a question about the legal authority for the Delaware Health Care Commission. As I understand, its authority stems from an executive order, but I cannot find it. I searched through this section, but could not find a mention of it.
Any thoughts are greatly appreciated.
Keep up the great work.
Scott
District of Columbia
Hi Scott-
It looks like the DHCC was actually created through legislation- I've included the relevant section of the Delaware code below. It's established as an independent public instrumentality.
Virginia
Thanks, Rachel -- very helpful.
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