State Insurance Exchanges Secure Conditional Approval from HHS

– HHS Secretary Kathleen Sebelius announced three more states that are tracking on time to implement health care law by establishing Health Insurance Exchanges (HIX). HHS issued the first conditional approval of a State Partnership Exchange to Delaware and Minnesota and Rhode Island.

Second Order Effects of the HIX Movement

State Exchanges are also key, as are Private HIX roll outs to enabling Accountable Care Organizations (ACOs). Other factors affecting HIX strategies include ICD-10 which will be the standard for describing the diagnosis of patients will be the lingua franca in the future for population health management. ICD-10 consulting assessments are underway for many hospitals, health plans and other HIPAA Covered Entities. CORE Operating Rules and the  mobile experience for the prospective member, patient and healthcare consumer will also be important as will be engaging the healthcare consumer after their purchase decision via healthcare Navigators and other wellness content.

Delaware secured conditional approval ahead of the Feb. 15, 2013, deadline to apply to operate a State Partnership Exchange.   The State Partnership Exchange enables states to manage part of the Exchange in 2014.  Partnership Exchanges enable states to make key decisions and tune the HIX to their  market.

Arkansas, Illinois, Iowa, and North Carolina have also expressed early interest in establishing a State Partnership Exchange.  HIX systems are more than just another Internet portal to shop for insurance.  They must comprehend individual income in pricing insurance to consumers, such as the MAGI calculation.

The Status of selected conditionally approved states are:

Colorado Insurance Exchange

Connecticut Insurance Exchange

District of Columbia Insurance Exchange

Kentucky Insurance Exchange

Maryland Insurance Exchange

Massachusetts Insurance Exchange(Health Connector)

Minnesota Insurance Exchange

New York Insurance Exchange

Oregon (Cover Oregon) Insurance Exchange

Rhode Island Insurance Exchange

Washington (Washington Health Plan Finder) Insurance Exchange

Conditionally Approved State Partnership Exchanges:


Delaware HIX

Michael F. Arrigo

Michael Arrigo brings four decades of experience in the software, financial services, and healthcare industries. In 2000, Mr. Arrigo founded No World Borders, a healthcare data, regulations, and economics firm with clients in the pharmaceutical, medical device, hospital, surgical center, physician group, diagnostic imaging, genetic testing, health IT, and health insurance markets. His expertise spans the federal health programs Medicare and Medicaid and private insurance. He advises Medicare Advantage Organizations who provide health insurance under Part C of the Medicare Act. Mr. Arrigo serves as an expert witness regarding medical coding and medical billing, fraud damages, as well as electronic health record software for the U.S. Department of Justice. He has valued well over $1 billion in medical billings in personal injury liens, medical malpractice, insurance fraud cases. The U.S. Court of Appeals considered Mr. Arrigo's opinion regarding loss amounts, vacating, and remanding sentencing in a fraud case. Mr. Arrigo provides expertise in the Medicare Secondary Payer Act, Medicare LCDs, anti-trust litigation, medical intellectual property and trade secrets, HIPAA privacy, health care electronic claim data Standards, physician compensation, Anti-Kickback Statute, Stark law, the Affordable Care Act, False Claims Act, and the ARRA HITECH Act. Arrigo advises investors on merger and acquisition (M&A) diligence in the healthcare industry on transactions cumulatively valued at over $1 billion. Mr. Arrigo spent over ten years in Silicon Valley software firms in roles from Product Manager to CEO. He was product manager for a leading-edge database technology joint venture that became commercialized as Microsoft SQL Server, Vice President of Marketing for a software company when it grew from under $2 million in revenue to a $50 million acquisition by a company now merged into Cincom Systems, hired by private equity investors to serve as Vice President of Marketing for a secure email software company until its acquisition and multi $million investor exit by a company now merged into Axway Software SA (Euronext: AXW.PA), and CEO of one of the first cloud-based billing software companies, licensing its technology to Citrix Systems (NASDAQ: CTXS). Later, before entering the healthcare industry, he joined Fortune 500 company Fidelity National Financial (NYSE: FNF) as a Vice President, overseeing eCommerce solutions for the mortgage banking industry. While serving as a Vice President at Fortune 500 company First American Financial (NYSE: FAF), he oversaw eCommerce and regulatory compliance technology initiatives for top ten mortgage banks and led the Sarbanes Oxley Act Section 302 internal controls IT audit for the company, supporting Section 404 of the Sarbanes Oxley Act. Mr. Arrigo earned his Bachelor of Science in Business Administration from the University of Southern California. Before that, he studied computer science, statistics, and economics at the University of California, Irvine. His post-graduate studies include biomedical ethics at Harvard Medical School, biomedical informatics at Stanford Medical School, blockchain and crypto economics at the Massachusetts Institute of Technology, and training as a Certified Professional Medical Auditor (CPMA). Mr. Arrigo is qualified to serve as a director due to his experience in healthcare data, regulations, and economics, his leadership roles in software and financial services public companies, and his healthcare M&A diligence and public company regulatory experience. Mr. Arrigo is quoted in The Wall Street Journal, Fortune Magazine, Kaiser Health News, Consumer Affairs, National Public Radio (NPR), NBC News Houston, USA Today / Milwaukee Journal Sentinel, Medical Economics, Capitol ForumThe Daily Beast, the Lund Report, Inside Higher Ed, New England Psychologist, and other press and media outlets. He authored a peer-reviewed article regarding clinical documentation quality to support accurate medical coding, billing, and good patient care, published by Healthcare Financial Management Association (HFMA) and is published in Healthcare IT News.

Leave a Reply