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Rebecca Farley

Director, Policy & Advocacy, National Council for Behavioral Health

CMS Releases Integrity Guidelines for Insurance Exchanges

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integrity guidelines

The Centers for Medicare & Medicaid Services has released a proposed rule to establish “integrity guidelines” for the online health insurance marketplaces that are to open for enrollment Oct. 1, 2013. The integrity guidelines are meant to safeguard federal funds and to protect consumers by ensuring that plan issuers and the exchanges themselves comply with federal standards related to affordability, quality, and more.

Much of the rule focuses on program integrity in the state-based health insurance exchanges that will sell qualified health plans in the individual and small group market, as well as on issuers offering coverage in the federally facilitated exchanges that will operate in 33 states that are not setting up their own exchanges. The proposed rule also establishes policies governing advance payments of the premium tax credit, cost-sharing reductions, and premium stabilization programs for low- and moderate-income people. A summary of the proposed rule is available in this CMS fact sheet.

CMS is now accepting public comments on the integrity guidelines; comments are due July 19. The proposed rule is available here through June 18; on June 19 it will be published in the Federal Register (search “CMS-9957-P”).