| Comment ID |
Organization Name |
Comment Type (Burden, Substantive, Other/Policy) |
Relevant Section in Original Certification Application |
Relevant Language in Original Certification Application |
Summary of Comment |
Comment Page # |
Accept or
Deny? |
CCIIO Response for PRA purposes |
| 1 |
State of Indiana |
Burden |
N/A |
N/A |
Certification and monitoring process should not be a lengthy and cumbersome process. The process needs to be nimble to respond to market changes. |
1 |
Accept |
We addressed this comment with the revised Certification Application, which is now more concise and involves a more streamlined process for States seeking Exchange certification/ approval. |
| 2 |
State of Indiana |
Other/Policy |
N/A |
N/A |
States will have limited time to meet Exchange requirements that are likely to be amended with upcoming regulatory updates. |
1 |
Deny |
Thank you, but this comment is outside of the scope of the Certification Application. |
| 3 |
State of Indiana |
Substantive |
Governance |
Provide a list of all current members and a resume for each member. |
States may not have selected or hired board members at time of application, and therefore may not be able to provide their names. States should be permitted to provide descriptions of jobs and descriptions of board seats in lieu of details. |
1 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 4 |
State of Indiana |
Other/Policy |
N/A |
N/A |
The Application should have requested comments on the State Partnership Exchange. |
2 |
Deny |
Thank you, but this comment is outside of the scope of the Certification Application. |
| 5 |
State of Indiana |
Substantive |
Federal Standards |
|
Requests an attestation of HHS intentions to be provided along side the state required attestation, that states will not interfere with federal standards. |
2 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 6 |
State of Indiana |
Substantive |
Consumer functions |
Display health plan quality rating information and enrollee satisfaction information |
Requests that rules on Quality rating be issued soon to enable states to develop compliant quality ratings and enrollee satisfaction Display requirements. |
2 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 7 |
State of Indiana |
Substantive |
Eligibility |
Provide evidence of capacity, including adequate staffing, to accept and process applications through channels including in-person, online, mail, and phone, and to conduct verifications. |
Requests revision of requirement for evidence of adequate staffing, and recommend a plan for adequate staffing be acceptable. |
2 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 8 |
State of Indiana |
Substantive |
Eligibility |
If not using the single, streamlined application provided by CMS, provide a copy of State-developed application. |
States may not have enough time to develop their alternative application since CMS has not released specifics about the application. States should only be required to signify their intent to develop a state specific application. The selection of the final version of the application should not be a condition of 1/1/13 Exchange approval. |
2 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 9 |
State of Indiana |
Substantive |
Eligibility |
Provide a description of relevant notices. |
Request publishing of rules regarding required notices. |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 10 |
State of Indiana |
Substantive |
Eligibility |
Provide Internal Revenue Service Safeguards Procedures Report letter of acceptance verifying adequate safeguards are in place to receive federal tax information which is required for eligibility determinations and renewals for Premium Tax Credit and cost-sharing reductions. |
Request inclusion of a note that state based Exchanges can cede this and other eligibility functions to the federal government. |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 11 |
State of Indiana |
Substantive |
IR Exemptions |
Provide a description of the exemption process, along with business process models |
Request inclusion of a note that state based Exchanges can cede this and other eligibility functions to the federal government. |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 12 |
State of Indiana |
Substantive |
QHP Certification and Plan Management |
Section 1311(d)(4)(A) of the Affordable Care Act requires that an Exchange must implement procedures for the certification, recertification, and decertification of QHPs. |
Consideration needs to be given to the release of System for Electronic Rate and Form Filing (SERFF) enhancements. This may affect those states that use SERFF for state rate filing requirements. QHP's implementation, oversight and monitoring may depend on SERFF's release and states implementation. |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 13 |
State of Indiana |
Substantive |
Financial Management |
Risk Adjustment Program Section 1343 of the Affordable Care Act defines requirements for adequate risk adjustment within the Exchanges. |
States may need more time to select the components of their risk adjustment program. |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 14 |
State of Indiana |
Substantive |
Consumer functions |
Describe who can assist and act on behalf of employers and employees in registering the employer, assisting in any employer and employee eligibility determinations, assisting employers in making available employer choices, and enrolling in health plans, |
States need a more flexible timeframe for implementing programs involving brokers, agents and navigators. |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 15 |
State of Indiana |
Substantive |
Reporting |
Please provide Implementation plan, including key milestones, high-level timeline, and detailed progress reports showing acceptable achievement of milestones, including readiness for initial open enrollment. |
In several sections of the Application, states are asked to provide reports. Commenter requests clarification as to what specific content is required in the reports. |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 16 |
State of Indiana |
Substantive |
Program Integration/ PCIP Transition |
Description of the plan for PCIP transition. |
Requests clarification on how states that have transferred PCIP administration to the federal government are to coordinate transition of PCIP enrollees to the Exchange. |
4 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 17 |
State of Indiana |
Substantive |
Governance |
If contracting out any oversight operation - provide name of contractor, contact point, address, evidence of contractor qualifications, and conflict of interest assessment. |
States may not be able to specifically identify contractors because they may not have selected specific contractors before the submission of the application. |
4 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 18 |
Blue Cross and Blue Shield Association |
Substantive |
Operational Readiness |
Please demonstrate operational ability to meet the requirements outlined in Parts 1 & 2. |
Operational readiness criteria should be clearly specified. |
1 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 19 |
Blue Cross and Blue Shield Association |
Other/Policy |
N/A |
N/A |
HHS should clarify what is required for conditional approval. |
1 |
Deny |
Thank you, but this comment is outside of the scope of the Certification Application. |
| 20 |
Blue Cross and Blue Shield Association |
Substantive |
Federal Standards |
Non-interference with Federal Standards Section 1311(k) of the Affordable Care Act specifies that an Exchange may not establish rules that conflict with or prevent the application of regulations promulgated by the Secretary related to the Exchange. |
HHS should adopt the requirement as specified in Section 1321(d) that would preempt state law if it "prevents the application" of the federal law. |
2 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 21 |
Blue Cross and Blue Shield Association |
Substantive |
Consumer functions |
N/A |
The proposed application should ensure states maintain critical consumer protections that will help ensure success of Exchanges. |
2 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 22 |
Blue Cross and Blue Shield Association |
Substantive |
Governance |
N/A |
HHS should give states more flexibility for Exchange governance. |
2 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 23 |
Blue Cross and Blue Shield Association |
Substantive |
Governance |
N/A |
Detailed information on contracted entities should be omitted as required data in the application. |
2 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 24 |
National Immigration Law Center |
Burden |
SHOP |
N/A |
Inquiry of immigration status of employees in the SHOP Exchange is not only disallowed under the ACA, it will saddle businesses with unnecessary administrative burden, defeat streamlining, thereby discouraging participation by small businesses. |
2 |
Accept |
We addressed this comment with the revised Certification Application; this requirement is no longer included in the Application and has been removed from the associated Exchange Final Rule. |
| 25 |
National Immigration Law Center |
Substantive |
Governance |
Contracted Entities Section 1311(f)(3)(B) of the Affordable Care Act authorizes an Exchange to enter into agreements with eligible entities to carry out one or more responsibilities of the Exchange. |
The Application should require states to include a specific description of how each contracted entity will comply with the nondiscrimination, as well as privacy, confidentiality and security protections of the ACA and related federal laws. |
2 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 26 |
National Immigration Law Center |
Substantive |
R/S Exchanges |
a. Regional Exchange Section 1311(f)(1) of the Affordable Care Act provides the option for States to establish Regional Exchanges that operate in more than one State if this operation is permitted by each State and if the Regional Exchange is approved by the Secretary of Health and Human Services. |
The Application should requires states to specifically demonstrate how the state, regional, and subsidiary Exchanges will comply with the nondiscrimination, as well as privacy, confidentiality and security protections of the ACA and related federal laws. |
2 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 27 |
National Immigration Law Center |
Substantive |
Consumer functions |
N/A |
Require the states to demonstrate how outreach and education will be done in a culturally and linguistically appropriate manner to ensure that all eligible individuals are aware of the new options for health insurance and their responsibilities. |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 28 |
National Immigration Law Center |
Substantive |
Consumer functions |
N/A |
Recommends a more inclusive interpretation of “advocates for hard to reach” populations that specifically includes advocates for individuals who need culturally and linguistically appropriate services. |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 29 |
National Immigration Law Center |
Substantive |
Consumer functions |
N/A |
State should also be required to demonstrate how the online insurance portal will be accessible to limited-English proficient individuals. |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 30 |
National Immigration Law Center |
Substantive |
Consumer functions |
Navigators Section 1311(d)(4)(K) of the Affordable Care Act requires an Exchange to establish a Navigator program. |
States should be required to describe in detail how the Navigator program meets federal requirements: reflect stakeholders interest including community/consumer focused non-profits, provide information that is fair, accurate and impartial, provide information in a culturally and linguistically appropriate manner, ensure accessibility and usability for the disabled, maintain expertise in eligibility and enrollment, comply with privacy and security provisions. |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 31 |
National Immigration Law Center |
Substantive |
Consumer functions |
Navigators Section 1311(d)(4)(K) of the Affordable Care Act requires an Exchange to establish a Navigator program. |
States must describe what standards and training will be put in place for Navigators. |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 32 |
National Immigration Law Center |
Substantive |
Consumer functions |
a. Agents/Brokers Section 1312(e) of the Affordable Care Act allows States to use agents or brokers to enroll individuals and employers. |
Agents and brokers must be required to comply with all privacy and security regulations of section 1411 g. |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 33 |
National Immigration Law Center |
Substantive |
Eligibility |
Eligibility Section 1411 of the Affordable Care Act defines eligibility criteria for Exchange participation. |
States should be required to show how their eligibility and redetermination processes comply with: Section 1411(g) which limits the information that may be collected from applicants to only what is “strictly necessary to authenticate identity, determine eligibility, and determine the amount of the credit or reduction;” and Section 155.310(a)(2) of CMS-9974-P which prohibits the Exchange from requiring Social Security numbers and information about citizenship or immigration status to be collected from non-applicants. |
4 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 34 |
National Immigration Law Center |
Substantive |
Eligibility |
Eligibility Section 1411 of the Affordable Care Act defines eligibility criteria for Exchange participation. |
Suggests that an applicant whose information cannot be electronically verified, and who is not in immediate possession of relevant documentation, should be given a reasonable period of at least 90 days to obtain the relevant documentation or to resolve the inconsistency, during which time they should be enrolled in a Qualified Health Plan (QHP) and provided advance payments of the tax credits based on the information attested to by the application filer. |
4 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 35 |
National Immigration Law Center |
Substantive |
Eligibility |
Eligibility Section 1411 of the Affordable Care Act defines eligibility criteria for Exchange participation. |
Suggests that states be required to demonstrate when language assistance services will be provided. |
4 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 36 |
National Immigration Law Center |
Substantive |
QHP Certification and Plan Management |
Section 1311(d)(4)(A) of the Affordable Care Act requires that an Exchange must implement procedures for the certification, recertification, and decertification of QHPs. |
Suggests that the Application require certification that applicants understand that ACA nondiscrimination, privacy, and language access requirements applicable to Exchanges are equally binding on QHPs. |
5 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 37 |
National Immigration Law Center |
Substantive |
SHOP |
Program (SHOP) Section 1311(b)(1) of the Affordable Care Act provides for the establishment of a SHOP Exchange that is designed to assist qualified employers in facilitating the enrollment of their employees in qualified health plans offered in the small group market in the State |
Suggests that the Application require that states demonstrate the eligibility and enrollment process for the SHOP is distinct from the enrollment process for the Individual Market Exchange, in order to minimize administrative barriers and help ensure small business employers will participate in the SHOP. |
5 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 38 |
National Immigration Law Center |
Substantive |
SHOP |
Program (SHOP) Section 1311(b)(1) of the Affordable Care Act provides for the establishment of a SHOP Exchange that is designed to assist qualified employers in facilitating the enrollment of their employees in qualified health plans offered in the small group market in the State |
Recommends that the SHOP’s main role should be to help facilitate the pre-enrollment process between the employer and QHP, but not to perform the enrollment functions. |
5 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 39 |
National Partnership for Women and Families |
Substantive |
General/Not Specific |
N/A |
Recommends that the Application clarify that states' implementation of the Exchange is bound to the content of their application/Exchange plan, and that states must seek HHS approval to make any significant deviation during the Exchange Implementation to what they proposed in their application. |
2 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 40 |
National Partnership for Women and Families |
Substantive |
Operational Readiness |
Please demonstrate operational ability to meet the requirements outlined in Parts 1 & 2. |
Request clarification on Operation Readiness standards. |
2 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 41 |
National Partnership for Women and Families |
Other/Policy |
N/A |
N/A |
Requests information on what the Exchange plan will be for a partnership Exchange and for a Federal Facilitated Exchange. |
2 |
Deny |
Thank you, but this comment is outside of the scope of the Certification Application. |
| 42 |
National Partnership for Women and Families |
Other/Policy |
N/A |
N/A |
Requests information on what standards HHS will use to review State applications, and specifically what will elicit a HHS approval, conditional approval or denial. |
2 |
Deny |
Thank you, but this comment is outside of the scope of the Certification Application. |
| 43 |
National Partnership for Women and Families |
Substantive |
General/Not Specific |
N/A |
Recommends that states are required to confirm that they are complying with ACA and relevant regulations. |
2 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 44 |
National Partnership for Women and Families |
Substantive |
Governance |
N/A |
Governing boards have consumer representation, including consumer groups and individuals, that constitute a majority of the board. |
2 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 45 |
National Partnership for Women and Families |
Substantive |
Governance |
Provide conflict of interest policy and procedure for preventing or mitigating conflicts of interest- include explanation if any conflicts of interest exist |
Recommends that governance boards are prohibited from having individuals with a conflict of interest. |
2 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 46 |
National Partnership for Women and Families |
Substantive |
Governance |
N/A |
Recommends that states that house the Exchange governance board within an already existing board be required to establish a stakeholder consultation process to ensure Exchange governance reflects consumer interests. |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 47 |
National Partnership for Women and Families |
Substantive |
R/S Exchanges |
N/A |
Recommends that states be required to provide adequate evidence that these alternative forms of exchanges will work well. |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 48 |
National Partnership for Women and Families |
Substantive |
R/S Exchanges |
N/A |
Recommends that states provide a memorandum of understanding stating that the non-discrimination laws and consumer protections of the state that the consumer resides in will apply to the resident. |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 49 |
National Partnership for Women and Families |
Substantive |
General/Not Specific |
N/A |
Recommends that the states be prohibited from discriminating against consumers in areas protected under section 1557 of ACA and other federal nondiscrimination provisions, as a condition of application approval. |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 50 |
National Partnership for Women and Families |
Substantive |
Consumer functions |
Provide a description of the approach to ensure sufficient consumer outreach, interpretation services, and overall consumer experience |
Recommends revising the application to clarify that in-person assistance is available. |
4 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 51 |
National Partnership for Women and Families |
Substantive |
Consumer functions |
Provide a description of the approach to ensure sufficient consumer outreach, interpretation services, and overall consumer experience |
States should be required to provide detailed description of how they will provide real time consumer assistance. |
4 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 52 |
National Partnership for Women and Families |
Substantive |
QHP Certification and Plan Management |
N/A |
Recommends that CMS establish a uniform federal floor for network adequacy and marketing standards. |
4 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 53 |
National Partnership for Women and Families |
Substantive |
General/Not Specific |
N/A |
States should be required to submit privacy policies that have been subject to public notice and comment. |
4 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 54 |
Families USA |
Substantive |
General/Not Specific |
N/A |
Requests clarification on what is specifically required for each key Exchange function. |
1 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 55 |
Families USA |
Substantive |
General/Not Specific |
N/A |
Requests publishing of federal standards for key Exchange functions that states can reference as a standard. |
2 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 56 |
Families USA |
Substantive |
Governance |
N/A |
Recommends that states be required to affirm in their governance authority that they have the authority to specifically establish an "ACA-compliant exchange". |
2 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 57 |
Families USA |
Substantive |
Governance |
Governance Section 1311(d) of the Affordable Care Act requires that an Exchange be a governmental agency or non-profit entity established by the State. The State may decide to establish an Exchange in an existing State agency or establish a new agency or non-profit organization to serve as the Exchange |
Recommends that states be required to show specific compliance with board composition federal requirements, and demonstrate staffing capacity |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 58 |
Families USA |
Substantive |
R/S Exchanges |
Regional Exchange Section 1311(f)(1) of the Affordable Care Act provides the option for States to establish Regional Exchanges that operate in more than one State if this operation is permitted by each State and if the Regional Exchange is approved by the Secretary of Health and Human Services. |
Request greater clarification on how regional exchanges are to use grant funding |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 59 |
Families USA |
Substantive |
R/S Exchanges |
Regional Exchange Section 1311(f)(1) of the Affordable Care Act provides the option for States to establish Regional Exchanges that operate in more than one State if this operation is permitted by each State and if the Regional Exchange is approved by the Secretary of Health and Human Services. |
Recommends that Regional Exchanges be required to demonstrate how they will coordinate eligibility in order to prevent consumers from falling in the cracks. |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 60 |
Families USA |
Substantive |
R/S Exchanges |
Regional Exchange Section 1311(f)(1) of the Affordable Care Act provides the option for States to establish Regional Exchanges that operate in more than one State if this operation is permitted by each State and if the Regional Exchange is approved by the Secretary of Health and Human Services. |
Recommends that states enter into a memorandum of understanding with state's department of insurance and regional exchanges to address variances between states in health insurance rating and consumer protection laws |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 61 |
Families USA |
Substantive |
Consumer functions |
Outreach and Education: Section 1311(d)(6) of the Affordable Care Act requires an Exchange to consult with relevant stakeholders, including: consumers, individuals and entities with experience in facilitating enrollment in health plans, representatives of small businesses and self-employed individuals, Sate Medicaid offices, and advocates for enrolling hard to reach populations. In addition, Section 1311(d)(4) lays out the functions of an Exchange, many of which will entail conducting of outreach and education for consumers as well as other stakeholders |
Requests that application include federal benchmarks or standards to help states understand what is required for: outreach plans, employee training, call center, and calculator. |
5 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 62 |
Families USA |
Substantive |
Consumer functions |
Navigators Section 1311(d)(4)(K) of the Affordable Care Act requires an Exchange to establish a Navigator program. |
Recommends that states be required to provide a funding description of strategy for Navigator program. |
5 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 63 |
Families USA |
Substantive |
Consumer functions |
Navigators Section 1311(d)(4)(K) of the Affordable Care Act requires an Exchange to establish a Navigator program. |
Recommends that states be required to demonstrate how they are considering the interests of the uninsured in designing the Navigator program. |
5 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 64 |
Families USA |
Substantive |
Eligibility |
Eligibility Section 1411 of the Affordable Care Act defines eligibility criteria for Exchange participation. |
Recommends requiring states to describe their online, phone, in-person application process. |
5 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 65 |
Families USA |
Substantive |
Eligibility |
Eligibility Section 1411 of the Affordable Care Act defines eligibility criteria for Exchange participation. |
Recommends requiring states to demonstrate compliance with ACA requirements for paper application |
5 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 66 |
Families USA |
Substantive |
Eligibility |
Eligibility Section 1411 of the Affordable Care Act defines eligibility criteria for Exchange participation. |
Recommend requiring states to provide details of how fluid the transfer of eligibility cases will be between relevant agencies |
5 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 67 |
Families USA |
Substantive |
Financial Management |
Provide a description of implementation plan, including key milestones and high-level timeline, for establishment of the Exchange financial management operations. |
Requests clarification on how states should submit proposed budgets, and how these budgets will be assessed. |
5 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 68 |
Families USA |
Substantive |
Enrollment |
N/A |
Recommends that enrollment dates are nationally standardized, and that states should be required to affirm in the application that their enrollment dates align with the national standard. |
5 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 69 |
Families USA |
Substantive |
SHOP |
N/A |
Recommend minimum federal standardized requirements for “how employer and employee contributions are calculated” and having the portal calculate and display the employee’s contribution for SHOP coverage. |
5 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 70 |
Families USA |
Substantive |
SHOP |
N/A |
Recommends standardization in “the role of the SHOP in billing employers, receiving employer and employee contributions toward premiums, making aggregated premium payments to issuers, and reconciling accounts.” |
5 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 71 |
Families USA |
Substantive |
Appeals |
N/A |
Recommend that the application ask states to certify their compliance with a federally required “safe harbor” where individuals will be able to remain covered during their appeals processes so that they do not experience gaps in coverage. |
6 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 72 |
Families USA |
Substantive |
Consumer functions |
N/A |
Recommends requiring states to provide proof of compliance with the Affordable Care Act’s insurance market reforms. |
6 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 73 |
Families USA |
Substantive |
Oversight |
N/A |
Recommends that states be required to describe how they will conduct regular evaluations of the functioning of their exchange and its ability to serve consumers. Such evaluations must be conducted by independent entities. |
6 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 74 |
Families USA |
Substantive |
Oversight |
N/A |
Recommends that states be required to describe a plan to prevent adverse selection of enrollees. |
6 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 75 |
Families USA |
Substantive |
General/Not Specific |
N/A |
Recommend that HHS clarify that this draft certification application applies specifically to fully state-run exchanges and that HHS will also be developing thorough documents to assess the readiness of Federally Facilitated Exchanges, whether they are fully federally facilitated or operated in partnership with a state. |
6 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 76 |
America's Health Insurance Plans |
Other/Policy |
N/A |
N/A |
When creating Exchanges, we believe it is imperative to avoid duplicating administrative functions and creating overly burdensome processes. States are faced with implementing Exchanges at a time when both resources and budgets are tight. |
1 |
Deny |
Thank you, but this comment is outside of the scope of the Certification Application. |
| 77 |
America's Health Insurance Plans |
Other/Policy |
N/A |
N/A |
Recommends transparency to the public; that applications, amendments, decision letters, and determinations that relate to the application process be made public. |
1 |
Deny |
Thank you, but this comment is outside of the scope of the Certification Application. |
| 78 |
America's Health Insurance Plans |
Substantive |
General/Not Specific |
N/A |
Recommends publishing of requirements HHS has outlined for contractors and vendors currently developing the federally facilitated Exchange’s system and platforms. |
1 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 79 |
America's Health Insurance Plans |
Substantive |
General/Not Specific |
N/A |
Recommends making available model Request for Proposal (RFP) templates for states to use, and providing states access to the systems and technology developed by vendors awarded the federal contracts for state-facilitated exchanges. |
1 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 80 |
America's Health Insurance Plans |
Substantive |
Operational Readiness |
Please demonstrate operational ability to meet the requirements outlined in Parts 1 & 2. |
Recommends providing clarification on the technical requirements and Exchange transactions to the states. |
2 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 81 |
America's Health Insurance Plans |
Other/Policy |
N/A |
N/A |
CMS should establish a process for expedited review of applications. |
2 |
Deny |
Thank you, but this comment is outside of the scope of the Certification Application. |
| 82 |
America's Health Insurance Plans |
Substantive |
General/Not Specific |
N/A |
States should be afforded a right of appeal for adverse determinations on its Application for Certification; and during the timeframe of the appeal, states should be afforded an extension on the application timeframe. |
2 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 83 |
America's Health Insurance Plans |
Substantive |
General/Not Specific |
N/A |
Recommends avoiding duplication of existing functions and relying on close coordination with existing agencies, especially state insurance regulators. Recommends that application include a description of the analysis of existing state agencies’ roles and responsibilities to assure that states have worked to eliminate duplication of efforts. States should be asked to demonstrate an integration of functions to eliminate administrative complexity, costs, and redundancies, with a goal of creating streamlined, cost-effective Exchange operations. |
4 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 84 |
America's Health Insurance Plans |
Substantive |
General/Not Specific |
N/A |
Recommends that the Application should provide for a process to protect confidential information, such as contractors identity and address, that does not impede the process for implementing Exchanges. |
4 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 85 |
Sargent Shriver National Center on Poverty Law |
Substantive |
Consumer functions |
Navigators Section 1311(d)(4)(K) of the Affordable Care Act requires an Exchange to establish a Navigator program. |
Suggests requiring states to discuss plan for oversight over Navigators. |
1 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 86 |
Sargent Shriver National Center on Poverty Law |
Substantive |
Enrollment |
Section 1312(a)(1) of the Affordable Care Act specifies that a qualified individual may enroll in any qualified health plan available to such individual. |
Recommends requiring states to explain disenrollment and reenrollment policies. |
1 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 87 |
Sargent Shriver National Center on Poverty Law |
Substantive |
Eligibility |
N/A |
States should be required to discuss notice and appeals processes for each of the determinations made. |
2 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 88 |
Sargent Shriver National Center on Poverty Law |
Substantive |
Enrollment |
N/A |
States should be required to discuss notice and appeals processes for each of the determinations made. |
2 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 89 |
Sargent Shriver National Center on Poverty Law |
Substantive |
IR Exemptions |
N/A |
States should be required to discuss notice and appeals processes for each of the determinations made. |
1 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 90 |
National Council on La Raza |
Substantive |
Enrollment |
N/A |
States should be required to discuss notice and appeals processes for each of the determinations made. |
1 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 91 |
National Council on La Raza |
Substantive |
Governance |
The submission of this application indicates your State’s formal application for certification as a State-based Exchange. |
Suggests inclusion of clarification in the preamble to the application that states that Exchanges are established and function under required consumer protections of ACA. |
1 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 92 |
National Council on La Raza |
Substantive |
Governance |
N/A |
Recommends that Governing Boards be required to have a member with expertise on the uninsured |
2 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 93 |
National Council on La Raza |
Substantive |
R/S Exchanges |
N/A |
Recommends clarification that regional and subsidiary exchanges are held to the same consumer protection standards a state exchanges |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 94 |
National Council on La Raza |
Substantive |
Federal Standards |
Non-interference with Federal Standards Section 1311(k) of the Affordable Care Act specifies that an Exchange may not establish rules that conflict with or prevent the application of regulations promulgated by the Secretary related to the Exchange. |
Section 1557 of the ACA and other federal nondiscrimination standards should be listed as a condition of Exchange approval |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 95 |
National Council on La Raza |
Substantive |
Consumer functions |
N/A |
Recommends that consumer tools take language and culture into consideration. |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 96 |
National Committee for Quality Assurance |
Substantive |
Consumer functions |
Provide a description of the approach to providing outreach and educational materials to the public about the Exchange |
States should be required to discuss notice and appeals processes for each of the determinations made. |
1 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 97 |
National Committee for Quality Assurance |
Substantive |
SHOP |
N/A |
Disenrollments should have an opportunity to cure or appeal the disenrollment decision before the effective date of the disenrollment. |
1 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 98 |
National Committee for Quality Assurance |
Substantive |
Consumer functions |
Section 1311(d)(4)(A) of the Affordable Care Act requires that an Exchange must implement procedures for the certification, recertification, and decertification of QHPs. |
Exchange Administrators should be required to provide written translations or provide taglines in documents that instruct how to access language services. |
1 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 99 |
National Committee for Quality Assurance |
Burden |
SHOP |
N/A |
Inquiries of SHOP Exchange employee's Immigration status is prohibited and is an unnecessary administrative burden |
2 |
Accept |
We addressed this comment with the revised Certification Application; this requirement is no longer included in the Application and has been removed from the associated Exchange Final Rule. |
| 100 |
The Center on Budget and Policy Priorities |
Substantive |
General/Not Specific |
N/A |
State Exchange Application should include citations to relevant regulations and guidance to help inform states’ responses to the Application. |
1 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 101 |
The Center on Budget and Policy Priorities |
Substantive |
Eligibility |
N/A |
Recommends revising the application to include the option that states CAN USE federally managed services |
1 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 102 |
The Center on Budget and Policy Priorities |
Substantive |
Enabling Authority |
N/A |
Recommends that information collected in Enabling Authority section should apply to both the individual market and the SHOP exchange. |
1 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 103 |
The Center on Budget and Policy Priorities |
Substantive |
Governance |
N/A |
Recommends that the application should require that states show that its Exchange board meets the federal standards for board composition in the federal regulations |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 104 |
The Center on Budget and Policy Priorities |
Substantive |
R/S Exchanges |
N/A |
States seeking to establish regional or subsidiary exchanges should be required to submit (as part of the State Exchange Application) a rationale for doing so. |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 105 |
The Center on Budget and Policy Priorities |
Substantive |
Consumer functions |
N/A |
Require states to describe their plan to ensure outreach and meaningful access to educational materials and information for people with Limited English Proficiency and people with disabilities |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 106 |
The Center on Budget and Policy Priorities |
Substantive |
Consumer functions |
N/A |
Require that states indicate what services will be provide in the call center, and describe the call center monitoring plan. |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 107 |
The Center on Budget and Policy Priorities |
Substantive |
Consumer functions |
N/A |
Recommend that state be required to describe how the portal will help ensure that there are seamless eligibility and enrollment processes for all insurance affordability programs: premium tax credits, Medicaid, the Children’s Health Insurance Program and Basic Health. States should be required to describe a monitoring service for the portal. |
4 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 108 |
The Center on Budget and Policy Priorities |
Substantive |
Consumer functions |
N/A |
Recommends that states be required to describe process for selecting Navigators, describe process to ensure that Navigators are meeting language and cultural needs, and that Navigators have the requisite expertise. |
4 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 109 |
The Center on Budget and Policy Priorities |
Substantive |
Consumer functions |
N/A |
Recommends that states should provide greater specification on agents and brokers roles and responsibilities. |
4 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 110 |
The Center on Budget and Policy Priorities |
Substantive |
Eligibility |
N/A |
States should be required to indicated how cases will be transferred between agencies. |
4 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 111 |
The Center on Budget and Policy Priorities |
Substantive |
Consumer functions |
N/A |
Recommends that section on brokers and navigators be separated because their roles are distinct. |
4 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 112 |
State of Louisiana |
Substantive |
Consumer functions |
N/A |
The application should require states to discuss how they will ensure that brokers and navigators include plan value in their discussions with consumers to help consumers make an informed decision. |
1 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 113 |
State of Louisiana |
Substantive |
QHP Certification and Plan Management |
N/A |
Application should ask states how they plan to use the quality data collected from issuers. |
2 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 114 |
Legal Services of Eastern Missouri |
Substantive |
Enabling Authority |
N/A |
Recommends that each state's enabling authority specify that it is facilitating an ACA-compliant Exchange. |
1 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 115 |
Legal Services of Eastern Missouri |
Substantive |
Governance |
N/A |
Suggests that states be required to provide HHS with a copy of any comments received in response to the states selection of a governing board. |
1 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 116 |
Legal Services of Eastern Missouri |
Substantive |
Governance |
N/A |
Recommends that governing boards be required to have members who represent consumers and the disable population |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 117 |
Legal Services of Eastern Missouri |
Substantive |
Governance |
N/A |
Recommends that members of governing boards should not have conflict of interest. |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 118 |
Legal Services of Eastern Missouri |
Substantive |
R/S Exchanges |
N/A |
States should provide documentation of how regional exchanges will use their grant funding. |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 119 |
Legal Services of Eastern Missouri |
Substantive |
Consumer functions |
N/A |
States should be required to list all tools that they will create to help consumer find and use affordable coverage. |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 120 |
Legal Services of Eastern Missouri |
Substantive |
Consumer functions |
N/A |
Recommends that the web portal be available in the 2 most common languages, in addition to English. |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 121 |
Legal Services of Eastern Missouri |
Substantive |
Consumer functions |
N/A |
Recommends that states conduct a needs assessment on consumer functions and use the feedback to design each other consumer functions. |
7 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 122 |
Legal Services of Eastern Missouri |
Substantive |
Consumer functions |
N/A |
Recommends that states require agents and brokers to agree to adhere to privacy requirements. |
8 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 123 |
Legal Services of Eastern Missouri |
Substantive |
Eligibility |
N/A |
Recommends that state be required to show how the Exchange will coordinate with Medicaid. |
8 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 124 |
Asian and Pacific Islander American Health Forum |
Other/Policy |
N/A |
N/A |
Linguistic and cultural barriers add complexities to the eligibility and enrollment process, preventing many in these populations from attaining quality health care. |
1 |
Deny |
Thank you, but this comment is outside of the scope of the Certification Application. |
| 125 |
Asian and Pacific Islander American Health Forum |
Substantive |
Enrollment |
N/A |
Recommends inclusion of federal requirement that all limited English proficient persons receive oral language assistance if needed. |
1 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 126 |
Asian and Pacific Islander American Health Forum |
Substantive |
Governance |
N/A |
Recommends that governing boards be required to include an individual with experience in minority health issues, either through policy and advocacy or direct health care service delivery. |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 127 |
Asian and Pacific Islander American Health Forum |
Substantive |
Federal Standards |
N/A |
Recommend clarification that Title VI of the Civil Rights Act of 1964 and Section 1557 of the ACA apply to both the individual Exchanges and the SHOP. |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 128 |
Asian and Pacific Islander American Health Forum |
Substantive |
Enrollment |
Provide a brief summary of approach for engagement of agents/brokers. |
Recommends revision in application to include engagement of agents/brokers working in racial and ethnic minority populations, limited English proficient persons and immigrants. |
3 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 129 |
Asian and Pacific Islander American Health Forum |
Substantive |
Notices |
N/A |
Suggests that states should be required to include a plan to publish notices in languages other than English. |
5 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 130 |
Enroll America |
Substantive |
General/Not Specific |
N/A |
Suggests that the application be revised to request specific, quantifiable metrics that are directly aligned to ACA. |
1 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 131 |
Enroll America |
Substantive |
General/Not Specific |
N/A |
Suggests that states be required to provide an evaluation plan as to how it will evaluate the Exchange's success. |
1 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 132 |
Enroll America |
Substantive |
General/Not Specific |
N/A |
Suggests that the application should be revised to request budget and staffing estimates. |
1 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 133 |
Enroll America |
Substantive |
R/S Exchanges |
N/A |
States should be required to discuss how partnership exchanges will work. |
1 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 134 |
Enroll America |
Substantive |
Consumer functions |
N/A |
States should provide more detailed information about their outreach strategies |
1 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 135 |
State of New York |
Substantive |
General/Not Specific |
N/A |
Application should not depend so much on yet to be released guidance. |
1 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 136 |
State of New York |
Substantive |
Operational Readiness |
Please demonstrate operational ability to meet the requirements outlined in Parts 1 & 2. |
Requests that HHS consider a states' effort to work collaboratively with HHS as an indicator of operational readiness, in place of actual evidence of operational readiness. |
1 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 137 |
State of New York |
Substantive |
Operational Readiness |
Please demonstrate operational ability to meet the requirements outlined in Parts 1 & 2. |
Requests clarification on factors that will be used to assess operational readiness |
2 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 138 |
State of New York |
Substantive |
General/Not Specific |
N/A |
Request a 2 part Certification Application process: Part 1 should only require state legislation that is created to enable the Exchange, Part 2: should include the detailed documentation and should not be due until 2013. |
2 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 139 |
American Federation of State, County and Municipal Employees |
Substantive |
Operational Readiness |
Please demonstrate operational ability to meet the requirements outlined in Parts 1 & 2. |
States' effort in working collaboratively with CMS should be considered as a factor in determining their level of readiness to operate an Exchange. |
2 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 140 |
American Federation of State, County and Municipal Employees |
Substantive |
Operational Readiness |
Please demonstrate operational ability to meet the requirements outlined in Parts 1 & 2. |
Requests clarification on factors that will be used to assess operational readiness |
2 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 141 |
American Federation of State, County and Municipal Employees |
Substantive |
Consumer functions |
Call Center Section 1311(d)(4)(B) of the Affordable Care Act requires an Exchange to provide for the operation of a toll-free telephone hotline to respond to requests for assistance. |
Requests clarification on how state portals will interact with healthcare.gov., and whether health plans will continue to submit information through Health Insurance Oversight System (HIOS) or to the Federal exchange. Recommend that healthcare.gov be a gateway to the states' portal. Support concept of shared dictionary among systems (HIPS, SERFF) to permit states to enter data one time and have it shared. |
2 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 142 |
American Federation of State, County and Municipal Employees |
Other/Policy |
N/A |
N/A |
Requests clarification of relationship between IT Gate reviews and the Certification process. |
2 |
Deny |
Thank you, but this comment is outside of the scope of the Certification Application. |
| 143 |
American Federation of State, County and Municipal Employees |
Substantive |
Eligibility |
N/A |
Request that Exchanges be required to ensure that Medicaid, premium subsidy, tax credit eligibility enrollment decisions be made by employees subject to merit personnel systems because such determinations are government functions. |
2 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 144 |
American Federation of State, County and Municipal Employees |
Substantive |
Consumer functions |
N/A |
Call center can perform Medicaid, premium subsidy, and tax credit enrollment decisions if it is a publicly operated. |
2 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
| 145 |
American Federation of State, County and Municipal Employees |
Substantive |
Appeals |
N/A |
Request that Exchanges be required to ensure that Appeal decisions be made my employees subject to merit personnel systems because such determinations are government functions. |
2 |
Accept |
We will take this under advisement for future iterations of the Certification Application or in future rulemaking. |
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