Tavenner details insurance-exchange preparations

Addressing executives of the nation's investor-owned hospitals, acting CMS Administrator Marilyn Tavenner on Tuesday explained how the CMS will spend 2013 preparing for the health insurance exchanges set to begin next year—and how hospitals can engage in those efforts.

“The good news is: most of the rules and regulation around the exchanges are complete, with what was released last Friday, so now we are full bore into implementation,” Tavenner told attendees at the Federation of American Hospitals' annual conference in Washington, referring to a series of rules that the agency issued last week.

Tavenner said the agency has conducted a lot of work with insurers, who will begin to submit data between now and late April that will be uploaded, exchanged and tested. After that, the CMS expects to begin reaching out to eligible beneficiaries around July to educate them in advance of open enrollment, which begins Oct. 1. Research has shown the CMS that beneficiaries tend to lose interest if they learn about new options that won’t be available to them for another six or seven months, Tavenner said. This summer, the agency plans to carry its message to a wide array of community venues, including churches and hospitals.

Tavenner outlined some ways that hospitals can begin helping patients learn what they might be eligible for starting in 2014.

“Many hospitals already have in their emergency departments—particularly if they are larger in size—some sort of Medicaid liaison,” Tavenner said. “So those Medicaid liaisons will have the information as well and they will be part of the folks that we train.” The CMS will also provide a Web portal and toll-free phone number for individuals to call and receive help from counselors on how to enroll.

States with state-based exchanges have funding set aside for in-person counselors on the exchange process, and the agency's “navigator program” for states that choose the federally run exchange will put counselors in place in certain areas that Tavenner called “high risk,” such as hospital emergency departments. Liaisons will also be available at the CMS' 10 regional offices across the country.

“So it's a very busy year, and I think we have all of the steps in place to get it done,” Tavenner said. “But we are going to need your help, and we're going to need your advice and guidance.”