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 is Managing Partner & CEO of No World Borders, a leading healthcare management and IT consulting firm. He serves as an expert witness in Federal and State Court and was recently ruled as an expert by a 9th Circuit Federal Judge. He serves as a patent expert witness on intellectual property disputes, both as a Technical Expert and a Damages expert. His vision for the firm is to continue acquisition of skills and technology that support the intersection of clinical data and administrative health data where the eligibility for medically necessary care is determined. He leads a team that provides litigation consulting as well as advisory regarding medical coding, medical billing, medical bill review and HIPAA Privacy and Security best practices for healthcare clients, Meaningful Use of Electronic Health Records. He advises legal teams as an expert witness in HIPAA Privacy and Security, medical coding and billing and usual and customary cost of care, the Affordable Care Act and benefits enrollment, white collar crime, False Claims Act, Anti-Kickback, Stark Law, physician compensation, Insurance bad faith, payor-provider disputes, ERISA plan-third-party administrator disputes, third-party liability, and the Medicare Secondary Payer Act (MSPA) MMSEA Section 111 reporting. He uses these skills in disputes regarding the valuation of pharmaceuticals and drug costs and in the review and audit of pain management and opioid prescribers under state Standards and the Controlled Substances Act. He consults to venture capital and private equity firms on mHealth, Cloud Computing in Healthcare, and Software as a Service. He advises ERISA self-insured employers on cost of care and regulations. Arrigo was recently retained by the U.S. Department of Justice (DOJ) regarding a significant false claims act investigation. He has provided opinions on over $1 billion in health care claims and due diligence on over $8 billion in healthcare mergers and acquisitions. Education: UC Irvine - Economics and Computer Science, University of Southern California - Business, studies at Stanford Medical School - Biomedical Informatics, studies at Harvard Medical School - Bioethics. Trained in over 10 medical specialties in medical billing and coding. Trained by U.S. Patent and Trademark Office (USPTO) and PTAB Judges on patent statutes, rules and case law (as a non-attorney to better advise clients on Technical and Damages aspects of patent construction and claims). Mr. Arrigo has been interviewed quoted in the Wall Street Journal, New York Times, and National Public Radio, Fortune, KNX 1070 Radio, Kaiser Health News, NBC Television News, The Capitol Forum and other media outlets. See and for more about the company.

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