Insurance Exchanges

These templates were released as part of the Paper Work Reduction Act notice, and represent the metrics that the Department of Health and Human services propose state-based marketplaces collect in order to monitor and evaluate their operations.

This final rule outlines Exchange standards with respect to eligibility appeals, agents and brokers, privacy and security, issuer direct enrollment, and the handling of consumer cases. It also sets forth standards with respect to a State’s operation of the Exchange and Small Business Health Options Program (SHOP).

On August 15, CMS awarded $67 million in Navigator Cooperative Agreements to 105 entities to serve in the 34 Federally-facilitated and State Partnership Marketplaces. This document lists the recipients of the Navigator grants, grouped by state.

This final rule provides standards for federally-funded navigator programs operating in federally facilitated and state partnership exchanges, federally-funded in-person assisters, and certified application counselors (CAC). All exchanges are required to have navigators and CACs, while the requirement to have assisters varies by exchange model. The rule includes standards related to conflict of interest, training and certification, accessibility, and SHOP-only navigators.

This rule finalized a slew of regulations related to the structure and operations of Medicaid, CHIP, and exchanges under the ACA. These include eligibility and enrollment requirements for qualified health plans and insurance affordability programs (Medicaid, CHIP, APTCs, and Basic Health Plans). It also detailed minimum standard requirements for Alternative Benefit Plans and changes to eligibility notices and appeals for Medicaid and CHIP. Additionally, it updated the criteria for verification of eligibility and enrollment in employer-sponsored insurance.