Observations Noted During the OIG Review of CMS's Implementation of the Health Insurance Exchange-Data Services Hub.

摘要

States must establish health insurance exchanges by January 1, 2014,1 and all health insurance exchanges must provide an initial open enrollment period beginning October 1, 2013 (45 CFR SC 155.410). Health insurance exchanges are State-based competitive marketplaces where individuals and small businesses will be able to purchase private health insurance. Exchanges will serve as a one-stop shop where individuals will get information about their health insurance options, be assessed for eligibility (for, among other things, qualified health plans, premium tax credits, and cost sharing reductions), and enroll in the health plan of their choice. A State may elect to operate its own State-based exchange or partner with the Federal Government to operate a State partnership exchange. If a State elects not to operate an exchange, the Department of Health and Human Services will operate a Federally Facilitated Exchange.2 For the purposes of this report, exchanges refers to all three types of health insurance exchanges. The Hub is intended to support the exchanges by providing a single point where exchanges may access data from different sources, primarily Federal agencies. It is important to note that the Hub does not store data. Rather it acts as a conduit for exchanges to access the data from where they are originally stored. The functions of the Hub will include facilitating the access of data by exchanges; enabling verification of coverage eligibility; providing a central point for the Internal Revenue Service (IRS) when it asks for coverage information; providing data for oversight of the exchanges; providing data for paying insurers; and providing data for use in Web portals for consumers.