The final rule incorporated provisions of two separate but related proposed regulations issued last year, on July 15 and Aug. 17. It included more flexibility than the earlier draft rules for states to determine eligibility for their exchange; provided greater detail on the role of agents and brokers in the exchange; and specified more privacy protections for enrollee data.
“The flexibility and guidance provided in today's final rule builds on the significant progress most states have already made,” said Tim Hill, deputy director of the Center for Consumer Information and Insurance Oversight at the CMS, in a call with reporters.
The rule also codified a “conditional approval” status for states that “have made significant progress” in creating an exchange but are expected to miss the January 2014 start date, according to Hill.
Other changes from earlier drafts included a provision allowing enrollees to purchase exchange-based insurance plan coverage through third-party websites operated by private entities.
The regulation's goal of offering states “substantial discretion” in both the design and operation of their exchanges drew praise from insurers.
“This rule recognizes that states are in the best position to establish exchanges because they have the experience and local-market knowledge needed to best meet consumers' needs,” Karen Ignagni, president and CEO of America's Health Insurance Plans, said in a written statement. The final rule does not cover all of the insurance exchange provisions of the Patient Protection and Affordable Care Act and additional rules will address those, according to the final rule. Also expected later, according to federal officials, are rules outlining federal exchanges that HHS will establish in states that are not prepared to launch their own.