Milestone: Determine policy goals for the Exchange
Determining the Exchange’s policy goals will inform other strategic decisions in areas such as governance, structure, and the Exchange’s plan selection strategy.
*Full name: Determine policy goals for the Exchange.
*Relevance to the ACA:
The ACA specifies the required functions of the Exchange while also allowing states flexibility to exceed many of these requirements. Provisions relevant to determining policy goals of the Exchange include:
§1311 - Details the required functions of Exchanges, including: certifying plans; operating a telephone hotline, a website to compare plans, a navigator program, and a cost-calculator; rating plans and presenting plan options for consumers; informing applicants of eligibility for public insurance programs and informing employers of workers who cease coverage; and accounting for exceptions to the individual mandate.
§1312 - Provides state flexibility to merge the individual and small group markets, continue with state benefit requirements, and continue operating a market outside the Exchange.
§1313 - Requires Exchanges to account for expenditures, report them to HHS, and comply with investigations and audits.less