Exchange Program Integrity
Sound accounting policies and practices help ensure a financially sustainable Exchange. These policies and practices, including financial reporting, also promote the Exchange’s accountability to management, government, and the public.
*Milestone details:
*Full name: Develop financial reporting, audit, internal controls, accounting policies, and other related practices for the Exchange.
*Relevance to the ACA:
The Exchange is subject to a number of accounting requirements and to the oversight of HHS and GAO. Relevant sections include:
§1311 - Eliminates federal funding for Exchanges beginning January 1, 2015 and requires that Exchanges be self-sustaining. Allows Exchanges to charge assessments or user fees or employ other methods to generate revenue. Prohibits Exchanges from using funds for giveaways, retreats or excessive compensation.
§1313 - Requires the Exchange to account for expenditures and be subject to annual audits. Allows investigations by the Inspector General of HHS into the activities of the Exchange. An Exchange must provide periodic reports of its activities if requested. The Secretary of HHS is authorized to take action by withholding funds from the state in the event of a pattern of fraud and abuse.
§1313 - Payments made to or through the Exchange are subject to the False Claims Act, which rewards whistleblowers who report misuse of federal funds.
§1313 - Before 2019, the GAO is required to undertake a study on Exchange activities and make recommendations for improvement.
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Kentucky
The Patient Protection and Affordable Care Act could transform state governments' role in the provision of health care. Health benefit exchanges, a critical component of the Act, are being developed in many states and on an accelerated timeline.
This whitepaper examines the role of health benefit exchanges, options for states in creating them, and the implications for state procurement officials and activities. Recommendations for states, such as the evaluation of alternative governance models and procurement laws, leveraging procurement officials, value-added capabilities, and staff training needs, will help state procurement officials play an important role in the creation and implementation of state health exchanges.
Oregon
I am asking for some advice in regards to the latest ammendments for SB 99. There are some lines of text that really concern me.
Would someone please review this document and advise me of the potential problems if any within this document.
I am working with the folks trying to get this passed and after returning from a conference in DC I am not sure all the ideas have made it into this document.
District of Columbia
Thanks for your comment, Ms. Anderson, and welcome to State Refor(u)m.
New visitors, feel free to respond to Ms. Anderson's question, or submit a new question, document, or idea that relates to this milestone!
District of Columbia
Senate Bill 38 was introduced in the NM legislature in 2011. It would establish the structure, governance, and duties of the Exchange.
Access the legislation here:
http://www.statereforum.org/sites/default/files/nm_sb0038.pdf
District of Columbia
This bill draft would establish a state Exchange as a quasi-public entity. Access the bill here: http://www.statereforum.org/sites/default/files/wi_exchange_bill.pdf
District of Columbia
This is an outline of proposed legislation to create the Wisconsin Health Insurance Exchange Authority. Access the outline here: http://www.statereforum.org/sites/default/files/wi_exchangecomments.pdf
District of Columbia
This application outlines MA's plans for enhancing and further developing the state's existing Exchange in order to ensure alignment with the ACA. Access the application here: http://www.statereforum.org/sites/default/files/ma_grant_narrative.pdf
District of Columbia
This application outlines KS's plans for the Exchange and how they would use the grant funds. Access the application here: http://www.statereforum.org/sites/default/files/ks_exchange_planning_gra...
District of Columbia
Introduced in the General Assembly as RB 921, this bill would establish a state-based Exchange. Access the bill here: http://www.statereforum.org/sites/default/files/an_act_establishing_a_st...
District of Columbia
This bill would establish an Exchange and align certain insurance regulations with the provisions of the ACA. Access the bill here: http://www.statereforum.org/sites/default/files/2011hb-06323-r00-hb.pdf
District of Columbia
This draft legislation would establish the Exchange under the office of the insurance commissioner and would require enrollees to purchase coverage through a broker. Access the bill here: http://www.statereforum.org/sites/default/files/iowa_sf391.pdf
District of Columbia
This draft legislation would create the Exchange as a nonprofit corporation under the office of the governor. Access the bill here: http://www.statereforum.org/sites/default/files/iowa_sf348.pdf
District of Columbia
Introduced in the Montana House as HB 124, this bill would establish a state-based exchange and governing board. Access the bill here:
http://www.statereforum.org/sites/default/files/hb0124-2.pdf
District of Columbia
North Carolina's HB 115 legislation would establish the Exchange as a nonprofit.
Access the legislation here:
http://www.statereforum.org/sites/default/files/h115v1.pdf
District of Columbia
Mississippi's HB 1220 bill would establish the Exchange as agency of the state.
Access the bill here:
http://www.statereforum.org/sites/default/files/hb1220_mi.pdf
District of Columbia
This bill would establish the Texas Health Insurance Connector and creates a governance structure, including a seven-member board. The bill lays out the functions of the Exchange, as required by the ACA, and requires the board to create a mechanism for aggregating payments from individuals through the Exchange to pay premiums as well as to set billing procedures for employers offering coverage. Access the bill here: http://www.statereforum.org/sites/default/files/hb00636i-7.pdf
District of Columbia
A presentation by Sandra Shewry on California’s recently passed health insurance exchange legislation, which covered issues other states might consider, such as purpose, governance, and authorities and tools. Access the presentation here:
http://www.statereforum.org/sites/default/files/nashp_shewry_ca_exchange...
District of Columbia
This document requests stakeholder comments regarding areas where the ACA leaves states flexibility related to implementation and the Exchange. Access the document here:
http://www.statereforum.org/sites/default/files/exchangecomments_100803-...
District of Columbia
This draft legislation would establish the Exchange as a nonprofit with a governing board. Access the bill here: http://www.statereforum.org/sites/default/files/mnhf0497.0_0.pdf
District of Columbia
This RFP outlines a scope of work for a needs assessment, including an analysis of the impact policy options on the insurance market, identifying a long-term source of financing, evaluating impacts on other state programs, and assessing current eligibility technology. Access the RFP here:
http://statereforum.org/sites/default/files/combinedexchangeplanningrfp-...