Federal & State Regulations | State insurance exchanges - District of Columbia

Summary of differences between federal and state regulations

The U.S. Department of Health and Human Services (HHS) must make a determination on or before January 1, 2013, that a state will in fact have an exchange in operation by 2014 and that the exchange meets the requirements of the Affordable Care Act (ACA) and HHS guidance. In a letter dated November 15, 2012, Secretary Sebelius indicated that states may submit both a letter of intent and an application to operate its own exchange by December 14. If a state elects not to operate an exchange, or if the HHS determines that the state will not be able to have an exchange operational by 2014 that meets the law’s requirements, the ACA gives the HHS the authority to establish and operate such exchange within the state.

The District of Columbia City Council gave final approval on December 20, 2011, to a bill establishing the District of Columbia health Benefit Exchange Authority, and Mayor Vincent Gray signed the legislation into law in January 2012, as Act 19-269. The legislation defines the District of Columbia Health Benefit Exchange Authority as a quasi-governmental organization.

The exchange will be governed by an 11-member board consisting of seven voting board members appointed by the Mayor, all of whom must be residents of the District of Columbia. There also will be four non-voting ex-officio members or their designees: the Director of the Department of Health Care Finance, the Commissioner of the Department of Insurance, Securities, and Banking, the Director of the Department of Health, and the Director of the Department of Human Services.

The legislation also calls for an Advisory Board consisting of nine members who are residents of the District of Columbia to provide recommendations to the Exchange Board on issues ranging from covered benefits to insurance standards.

To date, the District of Columbia Department of Health Care Finance has received a federal Exchange Planning grant of $1 million, as well as an $8.2 million Level One Establishment grant to leverage the data, information, and indicators in the preliminary planning into a comprehensive project design.

The District of Columbia must submit an exchange blueprint consisting of a declaration letter signed by the Mayor, and an application to the U.S. Department of Health and Human Services (HHS) by December 14, 2012, indicating whether it plans to operate an independent exchange or a partnership exchange with the federal government.