Client Alert: New York Issues "Invitation to Participate in the New York Health Benefit Exchange"

Health Reform - Epstein Becker Green

Our Epstein Becker Green colleagues Jane L. Kuesel, Jackie Selby, and Linda V. Tiano have released a client alert titled "New York Issues 'Invitation to Participate in the New York Health Benefit Exchange,' Clarifying Application Process and State Requirements."

The alert describes a number of the more significant requirements by New York on applicants that want to become eligible for certification as a Qualified Health Plan and to participate in the New York Exchange, as well as applicable time frames and processes.

Following is an excerpt:

The New York Department of Health’s Office of the New York Health Benefit Exchange issued the long-awaited “Invitation to Participate in the New York Health Benefit Exchange” (the “Invitation”) on January 31, 2013. The Invitation clarifies and summarizes the requirements for applicants to be qualified as eligible for certification as a qualified health plan, which permits them to be offered on the New York Health Benefit Exchange. Some of the more interesting and helpful features of the Invitation are summarized below. The full Invitation can be found online, along with a number of related attachments.

Read the full alert here.

Providers: Do Your Managed Care Participation Agreements Apply to New Insurance Exchange Products?

by Jackie Selby and Jane L. Kuesel

As enacted in the Patient Protection and Affordable Care Act, states are required to have established operational health benefit exchanges by January 1, 2014, or the federal government will implement one for them. These exchanges will allow individuals and small businesses to buy health care coverage and are expected to add approximately 30 million currently uninsured persons to the health insurance market. Most of the health plans that will be offered on such exchanges will be managed care plans with networks of participating providers. Thus, the resulting new business will be covered by hospital, physician, and other provider participation agreements with such managed care plans.

Read the full alert here