September 24, 2013
This is #12 in a series of Obamacare Reports. (See also postings by Mitchell Law Office)
The new Health Exchanges being developed under the Affordable Care Act (ACA) are required to accept applications for health insurance from individuals and small businesses, process these applications, establish eligibility for subsidies, and report back to applicants.
In the process of fulfilling these duties, each Exchange must swap information with a variety of federal agencies, including the Department of Health and Human Services (HHS) and the Internal Revenue Service (IRS). These functions are basically the same for federal, state, and partnership Exchanges.
Each Exchange is to function as a data processing center.
In order to swap information with federal agencies, as required, a “Data Services Hub” (Hub) is being created. The Hub functions like a giant switchboard, connecting the Exchanges to the federal agencies that must participate in processing applications.
The entire network is scheduled to become operational on October 1, 2013. One of the unknowns at this point is whether all of the information processing arrangements will be ready by this deadline.
Development of the Hub has been described in two reports by the Office of Inspector General (OIG) of HHS, dated August 2, 2013 and September 11, 2013. These reports focus on the data security aspects of the Hub, but also address its operational features.
HHS and its contractors are preparing the Hub. Coordination and testing are taking place among the Exchanges, the Hub, and federal agencies. Extensive test plans and procedures are being implemented.
Formal Interconnection Security Agreements (ISAs) are required for the federal agencies to “share or exchange information with external information systems and networks”. Written management authorization is required before such connections can “go live”.
The schedule is very tight. Final review of the ISAs for all agencies and Exchanges must be approved by September 30.
It is clear that the Exchanges, Hub, and participating federal agencies will all be under intense stress on October 1. The degree of success or failure of this arrangement will no doubt depend on how the software has been structured and written; whether there are software-hardware interface problems; how well data communications links work; and whether communications protocols are adequate to assure interconnectivity.
Operations will also be reliant on whether the federal agencies can internally process requests for information and provide timely responses, and whether the Exchanges can internally process applications, then request and receive needed information through the data Hub.
The success or failure on October 1 (and throughout October) will also depend on how susceptible the software is to “crashing”, how amenable the software throughout is to real-time fixes of “bugs” and unanticipated problems, and the skill and knowledge of the software analysis who are on “standby”.
There is an opportunity for attorneys to start becoming as familiar as possible with the information-handling operations of the Exchanges, in order to understand related issues that will be presented by clients in the future.
More on these and related topics may be found in a recent book by the authors that describes implementation of the ACA and its impact on legal practices.
Previous installments of “Obamacare Reports” address the various ways in which implementation of the ACA is affecting legal practices: