Under the reform law, states must notify HHS by 2013 of their intent to build an exchange and to have it operational in 2014. The federal government will develop an exchange in any state that refuses to do so. So far, 49 states and four territories have accepted federal planning grants for the initiatives, to be called Affordable Insurance Exchanges.
The proposed rule is
"The intent of this proposed rule is to afford States substantial discretion in the design and operation of an Exchange," according to the rule. "Greater standardization is proposed where required by the statute or where there are compelling practical, efficiency or consumer protection reasons. This proposed rule does not address all of the Exchange provisions in the Affordable Care Act; additional guidance on the establishment and operation of Exchanges will be provided in forthcoming proposed rules."
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