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• Develop considerations about setting up regional exchanges within the state.


Governor Perry threatened to veto legislation that would have authorized implementation of an exchange in Texas. A spokesperson for Governor Perry says the grant does not commit Texas to setting up an exchange. “This is an exploratory grant that the state applied for prior to the court rul- ings on Obamacare to help determine whether establishing an exchange is the best option for Texas, and does not re- quire the state to set up an exchange,” said Lucy Nashed, the governor’s deputy press secretary. “The governor has al- ways said he is committed to finding so- lutions to Texas’ health care challenges that are in the best interest of Texans, and that includes exploring all options available to the state.” The exchanges are intended to be


a one-stop marketplace for qualifying health plans beginning in 2014. States are required to demonstrate by Jan. 1, 2013, that they will have a functioning exchange in place by Jan. 1, 2014, or HHS will develop its own exchange for that state. In July, HHS proposed a framework to help states build insurance exchanges. The framework is designed to help sup- port and guide states in their efforts to implement exchanges. HHS proposed new rules offering states guidance and options on how to structure their ex- changes in two key areas:


• Setting standards for establishing ex- changes, setting up a Small Business Health Options Program (SHOP), performing the basic functions of an exchange, and certifying health plans for participation in the exchange; and


• Ensuring premium stability for plans and enrollees in the exchange, espe-


cially in the early years as new peo- ple come in to exchanges to shop for health insurance.


These proposed rules set minimum


standards for exchanges, give states the flexibility they need to design exchanges that best fit their unique insurance mar- kets, and are consistent with steps some states have already taken to move for- ward with exchanges. More than half of all states are tak-


ing additional action beyond receiving a planning grant, such as passing leg- islation or taking administrative action to begin building exchanges. States will continue to implement exchanges on dif- ferent schedules through 2014. HHS officials say the proposal builds


on more than a year’s worth of work with states, small businesses, consum- ers, and health insurance plans and of- fers states substantial flexibility. For ex- ample, it allows states to decide whether their exchanges should be local, regional, or operated by a nonprofit organization, how to select plans to participate, and whether to partner with HHS to split up the work.


HHS will accept public comments


on the proposed rules through Sept. 24. They may be submitted electronically at www.regulations.gov or by mail to Centers for Medicare & Medicaid Ser- vices, Department of Health and Human Services, Attention CMS-9989-P, PO Box 8010, Baltimore, MD 21244-8010. Be sure to reference file code CMS-9989-P whether submitting comments electroni- cally or by mail. To reduce duplication of effort and the administrative burden on the states, HHS also announced that the federal government will partner with states to make exchange development and opera- tions more efficient. States can choose to develop an exchange in partnership with the federal government or develop these systems themselves.


34 TEXAS MEDICINE September 2011


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