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Rules on Exchanges, Essential Health Benefits, Insurance Markets in Review

By Jane Norman, CQ HealthBeat Associate Editor

November 9, 2012 -- The Office of Management and Budget (OMB) is reviewing a proposed Health and Human Services rule that apparently will lay out the requirements for qualified health plans and the minimum standards for essential health benefits in insurance exchanges that the states will run.

In addition, a second proposed rule dealing with the specific regulations governing state health insurance markets also has arrived at OMB, where regulations are reviewed prior to publication. The exact contents aren't yet known, but HHS still needs to propose rules dealing with annual limits, community rating, exclusions for pre-existing conditions and more.

Just because the rules are at OMB doesn't mean they are immediately forthcoming. Sometimes proposals flow fairly rapidly through OMB, and sometimes it takes weeks or even months. However, that seems unlikely in this instance, given that implementation of the health care law needs to move forward.

Few details were available yet, but the appearance of the two proposed rules last week was particularly significant since they emerged just days after the reelection of President Obama. With enrollment in health insurance plans due to start in October 2013, states moving on exchange development have been awaiting additional guidance on the exchanges, the health plans they will market and the essential health benefits that will be included.

Some states have been moving ahead even without clear guidance because of the relatively short time before enrollment will launch.
HHS officials said in their description of the proposed rule on exchanges that it focuses on requirement for qualified health plans and is "implementation focused" on elements such as essential health benefits and oversight of the exchanges.

States that are moving ahead on exchanges recently submitted their benchmark plans for essential health benefits. Under the health care law (PL 111-148, PL 111-152), beginning in 2014, all non-grandfathered insurance plans in the individual and small-group markets have to cover a list of essential health benefits. The plans will be available in the exchanges, which are to be up and running by January 2014.

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