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Initiatives and Programs

The Center for Consumer Information and Insurance Oversight will undertake a number of initiatives as the Department of Health and Human Services works to implement the new health insurance reform law. Visit this page frequently for new information and updates.

Health Insurance Exchanges:

Establishment Grants

The Affordable Care Act authorized State Planning and Establishment Grants to help States establish health insurance Exchanges.  States can now apply for the second round of funding to continue their work on establishing their Health Insurance Exchanges.

State Planning and Establishment Grants

The Affordable Care Act authorized State Planning and Establishment Grants to help States establish health insurance Exchanges.  States can now apply for the first round of funding – up to $1 million for each State and the District of Columbia.  These grants will give states the resources to conduct the research and planning needed to build a better health insurance marketplace and determine how their Exchanges will be operated and governed. Through the establishment grant funding opportunity, States have multiple opportunities to apply for resources for implementing Exchanges.

Territory Cooperative Agreements

On January 20, 2011, HHS issued a cooperative agreement solicitation (also referred to as a Funding Opportunity Announcement, or FOA) publicizing the availability of the first round of funding for these cooperative agreements - up to $1 million for each Territory. These cooperative agreements will give Territories the resources to begin the early implementation activities needed to build a better health insurance marketplace and lay the groundwork for an operational Exchange.

Health Insurance Exchange Stakeholder Conference

The Affordable Care Act creates new competitive health insurance markets – called health insurance Exchanges -- that will give millions of Americans and small businesses access to affordable coverage and the same choice of health plans that Members of Congress will have.

In keeping with President Obama’s commitment to transparency and open government, the Department of Health and Human Services is seeking input from States, consumer advocates, employers, insurers, and other interested stakeholders like you on the structure of Exchanges and the standards that Exchange plans should be required to meet.  Already, we have published a Request for Comment, inviting the public to share their thoughts as HHS develops the policies that will govern the Exchanges.

Health Insurance Exchange Information Technology Systems

By providing a place for one-stop shopping, Exchanges will make purchasing health insurance easier and more understandable – and consumer-friendly IT infrastructure will be critical to their success.  Although Exchanges are not scheduled to start for a few years, work is already underway to design and implement them.  To help, HHS announced a new competitive “Early Innovators” grant announcement to reward States that demonstrate leadership in developing cutting-edge and cost effective consumer-based technologies and models for insurance eligibility and enrollment for Exchanges. HHS also issued guidance for IT systems to make them simple and seamless in identifying people who qualify for tax credits, cost sharing reductions, Medicaid or the Children’s Health Insurance Program (CHIP).  

Health Insurance Exchange Information Technology Systems

On November 12, 2010, HHS wrote to tribal leaders to initiate a consultation on the Indian-specific provisions related to the development of the Health Insurance Exchanges in the Affordable Care Act.

HHS Letter to Tribal Leader on Tribal Consultation

Consumer Assistance Program

Consumer Assistance Program Grants to States and Territories

The Affordable Care Act provides consumers with significant new protections including the ability to choose a health plan that best suits their needs, to appeal decisions by plans to deny coverage of needed services, and to select an available primary care provider of their choosing.

The new Consumer Assistance Grants program provides nearly $30 million in new resources to help States and Territories educate consumers about their health coverage options, empower consumers, and ensure access to accurate information. Grants have been made available to support States’ efforts to establish or strengthen consumer assistance programs that provide direct services to consumers with questions or concerns regarding their health insurance.

For more information about the program, refer to these postings:

Outreach and Education Resources

Consumer Operated and Oriented Plans (CO-OPs)

The Affordable Care Act calls for the establishment of the Consumer Operated and Oriented Plan (CO-OP) Program,  to foster the creation of nonprofit health insurance issuers to offer qualified health plans in the individual and small group markets. HHS will make loans to such nonprofit entities to fund start-up costs and award grants to assist them in meeting State solvency requirements.  These awards are to be made no later than July 1, 2013.1        

Consumer Operated and Oriented Plan (CO-OP) Advisory Board

  • As required by the Affordable Care Act, the Comptroller General established a 15 member advisory board on June 23, 2010 to make recommendations to the Secretary of Health and Human Services (HHS) on the award of grants and loans. The Committee will assist and advise the Secretary and Congress through the Department of Health and Human Services Center for Consumer Information and Insurance Oversight (CCIIO) on the Department's strategy to foster the creation of qualified nonprofit health insurance issuers. The Committee convened for the first time on January 13, 2011 and will convene again on February 7, 2011. Links related to the establishment of the Advisory Board and its meetings are provided below.   
  • Federal Register Notice -- Establishment 
  • Establishment Charter
  • Members of the Commission  
  • Federal Register Notice -- January 13th, 2011 FACA Meeting: This notice announces a forthcoming meeting of an advisory committee of the Center for Consumer Information and Insurance Oversight (CCIIO). The meeting is open to the public. Meeting Date: January 13, 2011 from 8 a.m. to 5 p.m., eastern standard time (e.s.t.). For more information, please see the Federal Register notice.

January 13th, 2011 FACA Meeting Documents

  • Agenda for January FACA Meeting (PDF - 63KB)
  • Executive Summary of January Meeting Notes  (PDF - 15.9KB)
  • Approved Minutes (PDF - 31KB)
  • Witness Testimony for January FACA Meeting:  The following written testimony was submitted in advance of the January 13th meeting.
    • Sara R. Collins, Ph.D. Vice President for Affordable Health Insurance, Commonwealth Fund. Sara R. Collins Testimony (PDF - 158KB)
    • Paul Hazen. President & CEO, National Cooperative Business Association. Paul Hazen Testimony (PDF -  245KB)
    • John M. Bertko, F.S.A., M.A.A.A. Senior Fellow at the LMI Center for Health Reform, Adjunct Staff at RAND, Visiting Scholar at the Brookings Institution, Visiting Scholar at the Center for Health Policy at Stanford and the retired Chief Actuary of Humana. John M. Bertko Testimony (PDF -  60KB)
    • Jay Ripps, F.S.A., M.A.A.A. Chief Health Actuary, Department of Insurance, State of California. Jay Ripps Testimony (PDF - 25KB)
    • Elizabeth Abbott. Director of Administrative Advocacy , Health Access California. Elizabeth Abbott Testimony (PDF - 44KB)
    • Sabrina Corlette. Research Professor, Health Policy Institute, Georgetown University. Sabrina Corlette Testimony (PDF - 103KB)
    • Cindy Palmer. CEO, Colorado Choice Health Plans, San Luis Valley, Colorado. Cindy Palmer Testimony (PDF - 32KB)
    • Mark Reynolds. CEO, Neighborhood Health Plan of Rhode Island. Mark Reynolds Testimony (PDF - 129KB)
    • Mary Dewane. Former CEO, CalOptima. Mary Dewane Testimony (PDF - 83KB)
    • Amit Bouri. Director of Strategy and Development, Global Impact Investment    Network. Amit Bouri Testimony (PDF - 180KB)
    • Peter Farrow. CEO and General Manager, Group Health Cooperative of Eau Claire, Wisconsin. Peter Farrow Testimony (PDF - 58KB)
    • Andrea M. Walsh. Executive Vice President and Chief Marketing Officer, HealthPartners of Minneapolis. Andrea M. Walsh Testimony (PDF - 67KB)
    • Diana Birkett Rakow. Executive Director of Public Policy, Group Health Cooperative. Diana Birkett Rakow Testimony (PDF - 60KB)
    • Sandy Praeger. Kansas Commissioner of Insurance, Chair, NAIC Health Insurance and Managed Care Committee. Sandy Praeger Testimony (PDF - 31KB)
    • Cindy Ehnes. Director, Department of Managed Health Care, State of California. Cindy Ehnes Testimony (PDF - 63KB)
    • Mike Kreidler. Washington Commissioner of Insurance. Mike Kreidler Testimony (PDF - 89KB)
  • Public Comment The following public comments were submitted in advance of the January 13th meeting.
    • John Morrison Montana Health Cooperative. (PDF – 22.6 KB)
    • Frank Knapp, Jr South Carolina Small Business Chamber of Commerce. (PDF – 46.6 KB)   
    • John Jemison Workers Cooperative National Association. (PDF – 100 KB)
    • Mark E. Rust Barnes & Thornburg LLP. (PDF – 15.4 KB)
    • Peter Beilenson Evergreen Maryland. (PDF – 92.6 KB)  
    • Rose Young First Carolina Care Insurance Company. (PDF – 48.3 KB)   
    • Margaret Murray Association for Community Affiliated Plans. (PDF – 89.7 KB)
    • Ken Barbic Western Growers. (PDF – 81.8 KB)
    • Scott Lyon Small Business Association of Michigan. (PDF – 32.8 KB)
    • Ken Crerar Council of Insurance Agents & Brokers. (PDF – 38.8 KB)
    • Nandini Kuehn Health Services Consulting.  (PDF – 27.1 KB)
    • Lendy Pridgen Capital Health Management, Inc. (PDF – 34.8 KB)
    • Bobette Bond Culinary Health Fund. (PDF – 73.1 KB)

February 7th, 2011 FACA Meeting Documents

Consumer Operated and Oriented Plan (CO-OP) Request for Comment

On January 28, HHS issued a Request for Comment to help inform the development of regulations governing the CO-OP program required by Section 1322.  Comments are due 30 days from the February 2, 2011 date of publication in the Federal Register.

Federal Register Notice – Request for Comment

Medical Loss Ratio

The provisions in Section 2718 of the Public Health Service Act (PHS Act), which was added by Sections 1001 and 10101 of the Affordable Care Act, require health insurance issuers to submit data on the proportion of premium revenues spent on clinical services and quality improvement, also known as the medical loss ratio (MLR), and to issue rebates to enrollees if this percentage does not meet minimum standards. The new law also directs the National Association of Insurance Commissioners (NAIC) to establish uniform definitions and standardized methodologies for determining what services constitute clinical services, quality improvement, and other non-claims costs for carrying out this provision.   

While the law requires NAIC to provide guidance by the end of the year, Secretary Sebelius has issued a letter to NAIC urging the association to provide guidance by June 1 to allow for the timely implementation of the new law. Read the letter

Premium Review

The Affordable Care Act includes a series of reforms to improve insurer accountability and consumer transparency.

On December 21, 2010, Secretary Sebelius proposed a new regulation to allow HHS to work with States to require insurers to publicly disclose and justify unreasonable rate increases.

Support for States

Pre-Existing Condition Insurance Plan

Section 1101 of the historic new health insurance reform law establishes a “temporary high risk health insurance pool program” to provide health insurance coverage to currently uninsured individuals with pre-existing conditions.  This program will be known as the “Pre-Existing Condition Insurance Plan.”

The new Pre-Existing Condition Insurance Plan (PCIP) is a transitional program to make health coverage available to those who have a pre-existing condition and who have gone without coverage for at least six months.

On April 2, 2010, U.S. Department of Health and Human Services Secretary Kathleen Sebelius issued a letter to governors and independent insurance commissioners asking each state to express its interest in participating in this program, which is funded entirely by the federal government.  Some states have requested that the federal government run their Pre-Existing Condition Insurance Plan.  Other states have requested that they run the program themselves. 

The Pre-Existing Condition Insurance Plan offers transitional coverage until 2014 when health insurance exchanges become available and pre-existing condition exclusions are prohibited.

You can read more about the Pre-Existing Condition Insurance Plan here. provides more details about the PCIP program in each State. Pre-Existing Condition Insurance Plan Enrollment, Updated Quarterly, Last Updated 11/5/2010.

Some states have indicated that they will run their own state run Pre-Existing Condition Insurance plan. Information provided to states includes:

For the other states that have requested that the federal government run their Pre-Existing Condition Insurance Plan, the plan will be operated by the U.S. Department of Health and Human Services in conjunction with the Office of Personnel Management and the USDA’s National Finance Center. The U.S. Department of Health and Human Services has contracted with the Government Employees Health Association (GEHA) to administer the Pre-Existing Condition Insurance Plan. GEHA is a long-time insurer for federal employee health care.

Applications will be processed by the USDA’s National Finance Center, which started accepting applications for enrollment on July 1, 2010 and offering coverage August 1, 2010.  People interested in the program can get more information at

Regulations announced on July 30, 2010 established standards necessary for the administration of the program and clarify certain issues not otherwise specified in the statute.

1 Sec 1322(b)(3)