At the point that the workgroup considered this option it was unclear which

At the point that the workgroup considered this

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Exchange, it did consider the partnership option. At the point that the workgroup considered this option, it was unclear which operational functions could be assumed by the state under the partnership option. Therefore, the workgroup examined all of the Exchange core functions to determine which functions would best be handled by a state agency or state-based Exchange, and those that would best left to the federal government. Consumer assistance . The workgroup recommended that the state provide consumer assistance directly to enrollees. A state-based Exchange would be better equipped to provide outreach and education to North Carolinians, as a state organization would already have knowledge of the state, the insurance industry, key consumer and small business groups, and other consumer support and eligibility sources such as those provided by the NCDHHS and local social services agencies. In addition, NCDOI already operates a successful consumer assistance program Health Insurance Smart NC (Smart NC) which helps consumers with insurance related questions, complaints, appeals, and external review. Not only does Smart NC provide key services to North Carolinians, but the information it collects as part of the complaint process is essential for NCDOI’s regulatory responsibilities. The workgroup also recommend ed that the Exchange contract to operate the call-center in state, as North Carolinians have a better understanding of the state’s health insurance marketplace and health care infrastructure. In addition, workgroup members recommended operating a state-based call center so that the state would benefit from the new jobs created. Some of the HBE workgroup members thought the
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Examining the Impact of the Patient Protection and Affordable Care Act in North Carolina Chapter 2: Health Benefits Exchange Page 42 federal government might be in the better position to create the “shop and compare” interface for the Exchange website, but they also recognized that the federal government would need to get a lot of the underlying data from the NCDOI. Thus, there was more of a consensus that the state- based Exchange take responsibility for creating the shop and compare website. Plan management . The workgroup recommended that the responsibility for certifying and decertifying qualified health plans be done at the state level. NCDOI traditionally monitors the operations of insurers, including plan licensure and solvency. Many of the Exchange plan management functions will be similar to traditional regulatory oversight functions, and are integral to the oversight of health plans offered through the Exchange. Further, the NCDOI will continue to regulate insurers outside the Exchange. Thus the state should also regulate and oversee plans operating within the Exchange. To minimize the possibility of conflicting rules operating inside and outside the Exchange, the workgroup recommended that a state-based Exchange (if created), along with NCDOI, assume responsibility for plan management. In
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