After the initial reforms in insurance plans taking place this year and next, what other changes will be made in the insurance realm? In the upcoming years 2012 and 2013, the Affordable Care Act provisions will be implemented to streamline the insurance process in both accessibility and simplification. Meanwhile, grants are being set up to help states start the exchanges. In other upcoming changes, the Department of Health and Human Services (HHS) is planning to further address health care quality by expanding data collection. More on these initiatives is below.



The CO-OP Program

In 2013, the Consumer Operated and Oriented Plan (CO-OP) program will be developed along with the exchanges, for the creation of qualified, nonprofit member-run health insurance issuers to offer qualified health plans in the individual and small group markets in the states. HHS will provide awards to parties applying to become qualified nonprofit health insurers through loans and grants for start-up costs and implementation. These loans and grants will be awarded by July 1, 2013. Around $6 billion in funding is set aside for the program.

In awarding loans and grants under the CO-OP program, HHS will consider recommendations from an advisory board. HHS is supposed to give priority to applicants that will offer the health plans on a statewide basis, utilize integrated care models, and have significant private support. HHS will ensure that there is sufficient funding to establish at least one qualified nonprofit health insurance issuer in each state.

If a state does not have a party apply to be a health insurance issuer, HHS can use grants to encourage the establishment of an issuer within the state, or the expansion of a qualified nonprofit health insurance issuer from another state to the state that lacks one.

Administrative Simplification of Plans

Another development in insurance reform is HHS' administrative simplification of health plans. Health plans will be required to adopt and implement uniform standards and operating rules for the electronic exchange of health information and a uniform set of operating rules. This provision is to reduce paperwork (i.e., number and complexity of forms), burdens, costs, and data entry required by patients and providers.

The operating rules should create as much uniformity in the implementation of the electronic standards as possible and reflect HIPAA standards. The set of operating rules for electronic transactions to determine eligibility for a health plan and health claim status shall be adopted by July 1, 2011, to be effective by January 1, 2013. Operating rules for electronic funds transfers and health care payment and remittance advice transactions shall be adopted by July 1, 2012, to be effective by January 1, 2014.

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