Amended by section 10104 of the Manager’s Amendment. Appropriates funding to HHS by March 23, 2011, to award planning and establishment grants to States to assist with the creation of Exchanges – available through January 1, 2015 – and provides for renewability if certain parameters are met. Requires States to create an Exchange, including a Small Business Health Options Program for small groups, to facilitate the purchase of Qualified Health Plans (QHPs).
Directs HHS to establish QHP certification criteria addressing a range of factors including marketing requirements, sufficient choice of providers, inclusion of essential community providers where available, QHP accreditation, implementation of a quality strategy, use of a uniform enrollment form and others as specified. Requires HHS to develop a QHP rating system on the basis of relative quality and price as well as an enrollee satisfaction survey. Addresses HHS’s role in providing a model template for States’ Internet portals, outlines enrollment periods and provides for the offering of standalone dental benefits through Exchanges. Allows States to require QHPs to cover benefits beyond those specified in ACA section 1302 as essential health benefits, although requires States to assume the cost of such additional benefits.
Establishes Exchanges’ role in implementing QHP certification, maintaining an Internet website, assigning QHP ratings, informing individuals about Medicaid eligibility, providing an electronic calculator reflecting post-advance premium tax credit coverage costs, certifying individuals’ exemptions to the individual responsibility requirement, establishing a Navigator program and other functions. Directs States to assure that Exchanges are self-sustaining beginning on January 1, 2015, and allows assessments or user fees on participating health insurance issuers. Directs Exchanges to consider plans’ premium increase information when determining whether to make such health plans available.
Sets transparency requirements under which plans disclose certain data to the Exchange, HHS and the State insurance commissioner, among several related requirements. Provides flexibility for regional, interstate or subsidiary Exchanges. Establishes QHP quality reporting – detailing the parameters of a quality strategy – and patient safety-related requirements. Sets the parameters for the Navigator program.