We’re getting into the nitty gritty of implementation, and there’s no shortage of questions about how states, the exchanges, and health insurers should operationalize some of the Affordable Care Act’s key requirements as we hurtle towards 2014. HHS’ Center on Consumer Information and Insurance Oversight (CCIIO) has a help desk for state officials and health insurers and the word is they’ve been inundated with inquiries. Last week CCIIO released answers to some of the most Frequently Asked Questions (FAQs) related to exchanges, as well as some of the new market wide reforms, including the modified community rating standard, the status of state high risk pools, and the definition of association health plans. Today they also provided relief for insurers on the ACA’s transparency requirements and extended the deadline for them to apply to the federally facilitated exchanges. A few toplines from this recent guidance, below:

• Exchange Marketing. CCIIO clarifies that states who are not in a partnership with the federal government for consumer assistance can still apply for and receive federal exchange establishment grants to conduct marketing activities. This will affect fully federally facilitated exchanges, as well as those states conducting plan management in partnership with the federal government, but not consumer assistance. Specifically, the guidance says:
  • Federally facilitated exchange or plan management partnership exchange states may use federal funds to conduct statewide marketing activities (including TV/radio buys, print ads, direct mail, social media, and digital/online ads), so long as their materials use federal messaging and language, are coordinated with HHS, and accessible to people with disabilities and limited English proficiency.
  • If a federally facilitated or plan management exchange state chooses to develop marketing materials for the exchange, they may “brand” them with a state emblem, such as the state flag or seal. However, the Federal Health Insurance Marketplace logo must appear on the materials.
• Association Health Plans. Back in 2011, the Administration issued regulatory guidance clarifying that individual and small group health insurance sold through an association would be regulated as individual and small group market insurance, respectively. This regulation brought association health plans under the purview of the ACA’s rate review provisions, even in states where this type of coverage had been considered “large group” coverage and was, therefore, exempt from state rate review requirements. This most recent guidance builds on the 2011 policy and clarifies that association health plans, if they sell coverage to any individuals or small groups, are subject to the ACA’s 2014 market rules, including the single risk pool requirements. The guidance notes: “each association member must receive coverage that complies with the requirements arising out of its status as an individual, small employer, or large employer.”
• Geographic Rating Areas. The FAQs clarify that small group market rating rules are based on the employer’s primary business location, not the employee’s address. Similarly, if a family buys a policy but has members who live in multiple locations, the geographic rating should be based on the address of the primary subscriber.
• State High Risk Pools. CCIIO clarifies that, to the extent states maintain their high risk pools after 2014, the enrollees in those risk pools will have the right to the guaranteed issue of any individual market health insurance offered inside and outside the Exchanges, and that states cannot prevent these individuals from moving to other health insurance products or to the Exchange.
• Transparency. Under the ACA, insurers must publicly report data relating to claims payment policies and practices, financial disclosures, enrollment and disenrollment, the number of claims denied, rating practices, out-of-network cost-sharing, enrollee rights, and other information deemed important by HHS. State and federal regulators can use this information to oversee and monitor health insurer behavior and better protect consumers. CCIIO’s recent guidance – which came out today – will allow insurers participating in the exchanges to defer reporting this data until after their plans have been certified for one year. This is in part because exchange plans will be, essentially, new plans, and insurers have noted that they will not have all the data they’re required to report before the end of the first benefit year. However, this doesn’t explain why CCIIO also extended the year-long grace period to insurers operating outside the exchange. Policymakers, state and federal regulators, and consumers will thus have to wait until at least 2015 to obtain the full transparency promised by the ACA.

These FAQs not only give exchange directors, insurers, and state regulators helpful guidance, they help provide a window for the rest of us to appreciate implementation challenges and what consumers might face when open enrollment begins in the fall. As the questions pile up, we’re sure to see more of this kind of guidance – stay tuned to CHIRblog for everything you need to know!