Do Your Managed Care Participation Agreements Apply to New Insurance Exchange Products? as appeared in The Advisory Board’s Law Review

Jackie Selby, a Member of the Firm in the Health Care and Life Sciences practice, in the New York office, and Jane Kuesel, a Senior Attorney in the Health Care and Life Sciences practice in the New York office, co-authored an article titled "Do Your Managed Care Participation Agreements Apply to New Insurance Exchange Products?"

Following is an excerpt:

(1) What is the timeframe and schedule for developing health benefit exchanges under the ACA?

Following an extension from HHS, the most significant near-term deadline for developing health benefit exchanges is on Dec. 14, 2012, at which time states are required to submit a declaration letter to operate a state-based exchange. For states choosing to run their own exchange, a blueprint application must also be submitted by this date detailing the state's readiness to perform exchange activities and functions. States electing to partner with the federal government to run their exchange are required to offer declaration letters and blueprint applications by Feb. 15, 2013.

By Jan. 1, 2013, HHS will make a determination if those state-based exchanges that have filed are far enough along to be functional in time for a Jan. 1, 2014 start date. HHS may grant either approval or a conditional approval.

While states that do not pursue a state-based exchange or federal-state partnership will have a federally facilitated exchange established by HHS, they may learn from this experience and transition to a state-based exchange or federal-state partnership in a subsequent year.

Although there remain some states that have yet to make a decision, as of Dec. 4, 2012, eighteen states have declared their intent to establish a state-based exchange, and have invested substantial time and resources—including federal grant money—to get their exchange up and running.

The attached file is used with permission from The Advisory Board Company.

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