Healthcare


HIX Final Rule Published - Covers Payment Details and Describes Appeals

by Patrick Riley 05 Sep 2013
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Late Wednesday night CMS released to the public the so called final-rule for health insurance marketplaces that "sets forth standards for agent and broker participation in government-facilitated insurance markeatplaces. It also requires qualified health plans that issue exchange products "to accept a variety of payment methods."

This iteration is all about oversight. Much like the Carter administrations effots to dilute Medicare fraud by creating the Healthcare Finanance Administration in the '70s or HCFA, this new iteration of governance provides the standards that establish oversight of health insurance issuers. "This will include HHS's focusing on ensuring compliance with market-lace-related standards while preserving states' traditional role in overseeing the individual and small group insurance market."

The 300 page document also includes a listing of the numerous ways consumers can make payments, which is very good for making the process that much easier. The rule also establishes processes for challenging eligibility miscues, due to the rights of applicants. It goes further to outline a formal process including a formal hearing if the appeals process does not go the direction consumers hoped.

You can follow my daily Tweets on Twitter @Patrick_FrostHC. As we draw closer to open enrollment we will be posting more than once daily on frost.com

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