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HHS Working on Contingency Plans in Case Exchanges Not Ready in Time

By Jane Norman, CQ HealthBeat Associate Editor

March 14, 2013 -- Federal officials are developing contingency plans in case the health insurance exchanges are not fully ready to begin enrolling people on Oct. 1, the head of the agency that’s building the massive 50-state marketplace structure said last week.

Gary Cohen, director of the Center for Consumer Information and Insurance Oversight, also said there is “some possibility” that some states now conditionally approved to run their own marketplaces might not be able to launch them on Oct. 1. But he vowed that every state will have an exchange, which could mean the federal government might have to have more of a role than anticipated in states that can’t get to the finish line in time.

His remarks at a national policy meeting of America’s Health Insurance Plans (AHIP) marked the first time that Health and Human Services (HHS) leaders have veered even slightly from their insistence that exchanges will be totally functional by Oct. 1. Cohen’s comments came on the same day that HHS Secretary Kathleen Sebelius conducted her second closed-door meeting with members of the Senate Finance Committee to discuss the health care law’s implementation.

Making contingency plans for October is necessary, Cohen said. “I think it’s only prudent to not assume everything is going to work perfectly on day one and to make sure that we’ve got plans in place to address things that may happen,” added Cohen, whose division is part of the Centers for Medicare and Medicaid Services (CMS).

Cohen appeared on an AHIP panel with Henry Chao, a CMS official who’s overseeing the technology for the exchange launch.

Chao was frank about the stress and tension of the compressed time frame involved in setting up the exchanges. “We are under 200 days from open enrollment, and I’m pretty nervous,’’ he said. “I don’t know about you,” he added, to murmurs from the insurance industry audience. Members peppered Chao and Cohen with many questions about the format for the health care policies they will submit to HHS for approval so the plans can be marketed in the exchanges.

Chao said the main objective is to get the exchanges up and running and signing up the uninsured. “The time for debating about the size of text on the screen or the color or is it a world-class user experience, that’s what we used to talk about two years ago,” he said. “Let’s just make sure it’s not a third-world experience.”

Cohen said his staff continues to work toward the October start date and expects that the exchanges will be ready to oversee enrollment in insurance plans by individuals and small businesses. There are 18 exchanges expected to be run by states and the District of Columbia, seven by state-federal partnerships and 26 by the federal government.

But “there is contingency planning that is going on to address foreseeable things that may be problematic on day one,” Cohen said. “Everyone recognizes that day one will not be perfect.”

No Backup Details
Cohen would not be much more specific and said details of backup plans are not yet worked out. “But as we move closer to October, my hopes are the range of things that could go wrong gets narrower and narrower,” he said. “Then we will be in a position to know better which contingency plans we actually have to implement.”

Speaking with reporters afterward, Cohen said, “I’m absolutely confident every state will have an exchange that will be functioning and ready for enrollment” on Oct. 1. However, he added, “I think there is some possibility that the type of exchange may be different than what we’re looking at today.”

He noted that 18 states have been “conditionally” certified to run their own exchanges, which means approval is not yet final. “There are conditions on that they have to meet to be operational,” Cohen said. “That’s a process that’s ongoing. We are working with every state and hope that they all get there.”

He would not estimate how many of the 18 states might not be ready but said repeatedly that no state will be left high and dry without an exchange. The federal government is required by the health care law (PL 111-148, PL 111-152) to operate exchanges in states that don’t have them. “There will be an exchange in every state,” Cohen said.

Some states may just run out of time to develop their eligibility and enrollment systems, he said. “I think the biggest challenge is for states that started later,” Cohen said. “Obviously they have less time. Some states were way out in front. Our early innovators were out in front, got their grants, got working very quickly. Other states have come in later. We welcome that. We are glad they are engaged and they are working with us. But it’s really a challenge for them.”

Some states have had challenges to their legal authority to implement state-based exchanges, he noted.

As for the contingency plans, Chao said that “we are having those discussions” and that a different section of the Centers for Medicare and Medicaid Services has been asked to develop options because CCIIO officials are so tied up with putting the exchanges in place.

“We are having those discussions, but they’re not fully baked yet,” said Chao, deputy chief information officer for the Office of Information Services at CMS. But he indicated that the contingency plans will include everything the exchanges are expected to do — from computer operations to call centers.

“There’s at least one for every aspect of the functions we are trying to put in place and the various models that are being implemented,” Chao said.

Cohen acknowledged that some members of Congress want more input from HHS about implementation in their states. “It’s perfectly understandable people have concerns. This is a big thing we’re doing,” he said. “We’re doing the best we can to make sure folks are aware of all the work we’re doing.”

Jane Norman can be reached at [email protected].

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