States have until Jan. 1, 2013 to obtain federal approval for their exchanges. Among the rule's key elements:
— States can receive conditional federal approval for their exchanges if their plans are far along but not final by Jan. 1, 2013. States can operate exchanges in partnership with other states. The federal government will provide funding for different types of exchanges to allow for flexibility.
— The state exchanges themselves will determine the number and type of health plans offered to consumers, within broad standards set by the federal government. Plans will have to comply with marketing rules to ensure they are not trying to cherry-pick the healthiest customers in the state.
— Consumers must be able to apply online for coverage in their state exchanges. To reduce paperwork, exchanges will rely on existing computer databases to verify basic personal information and eligibility. However, some key details, such as whether the consumer is a legal resident of the U.S., may have to be verified by the government. And the IRS will have final say on tax credits.
— Exchanges must be able to pick from two federally approved methods for coordinating with the Medicaid program in their states.
— Exchanges must be able to use intermediaries called "navigators" to help educate consumers and small businesses about how the new system works.
— Exchanges must be financially self-sufficient by 2015, by charging fees to support their operations.
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