State insurance exchanges -Pennsylvania

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.

Pennsylvania is currently studying its options. In 2011, the state legislature introduced two bills (HB 627 and SB 940) that would establish a state-based health insurance exchange. While there has been no action on the bills since April 2011, Pennsylvania’s two-year legislative cycle allows the bills to carry over to 2012. In the meantime, the Pennsylvania Insurance Department has taken the lead with exchange planning.

The state received a $1 million federal Exchange Planning grant and a $33.8 million Level One Establishment grant.

December 14, 2012, is the deadline for Pennsylvania to submit an exchange blueprint consisting of a declaration letter signed by Governor Corbett and an application to the U.S. Department of Health and Human Services, if it intends to operate a state-based exchange or a state-federal partnership exchange. However, without legislation in place, it is unlikely the state will meet the federal timetable for implementation.

State

Contacts

Pennsylvania Insurance Department

Regulations

HB 627

SB 940

Federal

Contacts Center for Consumer Information and Insurance Oversight (CCIIO)

U.S. Department of Health and Human Services (HHS)

Regulations

45 CFR Parts 155, 156, and 157