NU Online News Service, March 7, 3:25 p.m.EST

Every state will have a health insurance exchange—whetheroperated by a particular state or by the federal government—whenthe system is scheduled to be implemented on Jan. 1, 2014, the headof the government bureau implementing the healthcare law says.

Clearly the launching of exchanges system will rest on whetherthe Patient Protection and Affordable Care Act (PPACA) is upheld bythe Supreme Court, says Steve Larsen, deputy administrator anddirector of the Center for Consumer Information and InsuranceOversight (CCIIO) at the Department of Health and Human Services.The CCIIO is part of the Centers for Medicare and MedicaidServices.

“It will be one of the most important decisions [by the court]in a long time,” he says.

As to the final rule implementing the exchanges, Larsenindicates that the release is imminent.

He used the words, “very soon” and “very close” in discussingthe exchange regulations, but an aide declined to confirm or denywhether those rules are resting with the Office of Management andBudget, which has the final say in approving a proposed or finalfederal regulation.

Larsen made his comments yesterday as the opening speaker at the2012 National Policy Forum of America's Health Insurance Plans,being held yesterday and today in Washington.

At the same time yesterday, HHS released on the NationalAssociation of Insurance Commissioners' website the latest revisedversion of its “recommended approach” for an updated state-specificthreshold for rate increases.

It appears HHS has determined that the threshold for examiningproposed rate increases by insurance companies will remain at 10percent.

In the announcement, CCIIO says, “…based on available data, itappears that medical costs are not increasing at a faster rate thanthey were in December 2010, when the proposed regulation waspublished.”

The proposal adds, “This would appear to argue against anyincrease in the threshold for reviewing rate increases. Theprocess described below would provide an opportunity for States topresent evidence of unique conditions that would justify athreshold higher than 10 percent. However, HHS would be moreinclined to grant a request from a State that the threshold belower than 10 percent.”

Larsen says that HHS reviewed 12 proposed rate increases instates where the governments declined to get involved, and foundthat 6 were unreasonable increases and 6 were not.

The comment period on the proposal ends March 12th.

Larsen also says that HHS has completed reviews of 18 staterequests for exemptions or exceptions on the medical loss ratioformula, rejecting 11, adjusting six and fully approving Maine'srequest.