Exchange Governance
Governance choices will shape Exchange operations, accountability, and the impact of the Exchange on health insurance markets. States will want to align governance decisions with their overall Exchange goals and priorities.
*Milestone details:
*Full name: Establish governance of the Exchange
*Relevance to the ACA:
The ACA requires that the Exchange be a nonprofit entity or governmental agency established by a state, but gives states great flexibility within these broad parameters. Sections relevant to Exchange governance include:
§1311 - Creates grants for states to plan and launch Exchanges. Requires Exchanges to be nonprofit entities or governmental agencies.
§1321 - Requires the Secretary to give guidance related to the creation of Exchanges. This section also gives the Secretary 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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New Jersey
Here is a link to a white paper by John Jacobi, J.D. of Seton Hall Law School analyzing key issues central to the design of a health insurance exchange in New Jersey and providing guidance on how to design the governance of an exchange such that it complies with federal and state law, meshes with New Jersey’s legal and public policy history, and is calculated to perform its functions as expeditiously and efficiently as possible.
http://www.cshp.rutgers.edu/Downloads/9020.pdf
District of Columbia
Like other state health officials, exchange leaders may want an ongoing forum to collaborate, share knowledge and best practices, and to represent their interests as appropriate. This report explores models of collaboration, from formal associations to informal networks, among state officials in order to inform exchange directors about options for sustainable ongoing support. The paper is based on research and interviews NASHP conducted with leaders representing six organizations supporting state officials, and it explores the strategies for membership, governance, business models, and activities of each.
Virginia
Attached you will find a December 2011 report from the Virginia Health Reform Initiative with recommendations on the establishment of a Health Benefit Exchange for the Commonwealth.
North Dakota
North Dakota’s Exchange bill was defeated during a special legislative session last week. House Bill 1474 would have created a new division in the Governor’s Office of Management and Budget (OMB). The fiscal note indicated a cost of almost $40 million and 28 FTEs (mostly for IT). The Insurance Commissioner and Director of the Department of Human Services (Medicaid) would have sat on the board of the Exchange as non-voting members. The bill failed the House after a lengthy debate 64-30.
See a summary of measure actions here:
District of Columbia
This issue brief touches on creating good governance structures for state exchanges.
West Virginia
Attached is the West Virginia Health Benefit Exchange Request for Comment announcement.
This link will take you to WV stakeholder responses to the RFC:
http://www.wvinsurance.gov/LinkClick.aspx?fileticket=YOZw755W4K0%3d&tabi...
West Virginia
SB 408 creating the West Virginia Health Benefit Exchange passed the WV Legislature on March 12, 2011 and was signed into law by Governor Earl Ray Tomblin on April 5, 2011. We have attached both the enrolled bill and a legislative summary.
District of Columbia
This report provides lessons learned from MA that are relevant to national health reform implementation, including: Exchange issues, stakeholder engagement and educating consumers. Access the report here:
http://www.statereforum.org/sites/default/files/lessons_for_national_ref...
District of Columbia
This bill, introduced by the House of Representatives, would establish a state health benefits Exchange and requires its governance structure to be in place by July 2012. The bill leaves many future decisions up to the legislature and governor, but does specify that the Exchange shall be governed by a public-private partnership. The Washington State Health Care Authority, in consultation with the legislature’s Joint Select Committee on Health Reform Implementation, would develop a set of options for a variety of implementation decisions. Access the bill here: http://www.statereforum.org/sites/default/files/1740-s.pdf
District of Columbia
This bill establishes a Health Benefits Exchange and creates a health benefit development board. The board is charged with creating a development plan that contains recommendations on goals, functions, governance, regional exchanges, financial sustainability, market impacts, and plan certification. Access the bill here: http://www.statereforum.org/sites/default/files/wa_sb5445.pdf
District of Columbia
This presentation covers the Health Insurance Partnership in WA and provides information on early planning for the Exchange, including Exchange functions, important policy decisions, and key implementation dates. Access the presentation here: http://www.statereforum.org/sites/default/files/wa_exchanges.pdf
District of Columbia
This document covers in depth questions relevant to Exchange planning and implementation, identifying where the ACA provides guidance, where further guidance is needed and factors that need to be considered when making decisions around the Exchange structure. Access the document here: http://www.statereforum.org/sites/default/files/exchange_questions_sep_2...
District of Columbia
This presentation provides an overview of the aim of the Exchange and state Exchange requirements, and outlines the differences between the market inside and outside the Exchange. Access the presentation here: http://www.statereforum.org/sites/default/files/mpa_exchange.pdf
District of Columbia
This draft legislation establishes a Health Benefits Exchange and creates a health benefit development board. The board is charged with creating a development plan that contains recommendations on goals, functions, governance, regional exchanges, financial sustainability, market impacts, and plan certification. Access the draft here: http://www.statereforum.org/sites/default/files/waexchange_draftlegislat...
District of Columbia
This grant application outlines how WA will make use of funds to help plan for a state-governed and administered health insurance exchange.
Access the grant application here: http://www.statereforum.org/sites/default/files/health_exchange_grant_pa...
District of Columbia
This document lists important questions for Exchange planning to be answered in future issue briefs and possibly by an Exchange Development Board. Questions are in such areas as organizational structure, functions and responsibilities, administration, and sustainability. Access the document here: http://www.statereforum.org/sites/default/files/waexchange_keyquestions_...
District of Columbia
Molly Voris of the Washington Health Care Authority shared the state's enacted Exchange enabling legislation. Access the legislation here: http://www.statereforum.org/sites/default/files/final_5445.pdf
District of Columbia
These draft policy recommendations on an insurance Exchange were submitted to the OR Health Policy Board. Access the draft recommendations here: http://www.statereforum.org/sites/default/files/or_oha_expolicyrecs_0813...
District of Columbia
These comments to HHS outline the major factors OR plans to consider in developing an Exchange. Access the comments here: http://www.statereforum.org/sites/default/files/or_hhspublic_comments.pdf
District of Columbia
This presentation by the Oregon Health Authority outlines key action steps the state must take to implement its comprehensive health reform plan and includes elements of federal reform. Access it here: http://www.statereforum.org/sites/default/files/or_axn_plan_12.10.pdf
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