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Overview of Exchange Approval Requirements
HHS may approve States that seek to operate a State-based Exchange or participate in a State
Partnership Exchange based upon a State’s submission of its Blueprint. A Blueprint is made up of two
components:
• Declaration Letter (Section 1)
• Exchange Application (Section 2)
States seeking to operate a State-based Exchange must submit a Declaration Letter and a Blueprint
Application no later than 10 business days prior to January 1, 2013 (December 14, 2012 for plan year
2014). States seeking to operate in a State Partnership Exchange for plan year 2014 can submit their
Declaration Letter and a Blueprint Application any time before February 15, 2013 and may receive
approval on a rolling basis any time before March 1, 2013.
A State may submit its Declaration Letter at any time prior to this deadline. If a State’s Declaration
Letter is received more than 20 business days prior to the submission of its Blueprint, the State may
request an Exchange Application consultation with CMS regarding preparation of its application for
approval as a State-based Exchange or State Partnership Exchange.
States that plan to operate in the Federally-facilitated Exchange without Partnership that intend to
operate their own reinsurance programs—should submit a Declaration Letter addressing how they
meet or will meet the requirements of Section 5.2: Reinsurance program. They are invited to submit a
Declaration Letter otherwise, but they do not need to complete the Exchange Application.
In particular, HHS strongly encourages States that are considering operating a State-based Exchange
or a Plan Management Partnership to submit the Declaration Letter as soon as possible and to seek
technical assistance and consultation with HHS to ensure State readiness to operate Plan Management
activities in time for operational implementation.
States that seek HHS Approval to operate a State-based Exchange or State Partnership Exchange for
coverage years beginning after January 1, 2014 (e.g., January 1, 2015, January 1, 2016) should submit
an Exchange Blueprint in accordance with the same process and timeframe specified for those States
seeking to operate an Exchange on January 1, 2014, for the applicable year.
Initial Exchange Approval Determinations
HHS will approve a State-based Exchange once the State has demonstrated the ability to satisfactorily
perform all required Exchange activities.
HHS recognizes that States depend on HHS and other Federal agencies for guidance associated with
their Exchange establishment. In this regard, particularly in the first year of the program (plan year
2014), approval of State-based Exchanges will take into account timelines for guidance and
infrastructure development (e.g., Data Services Hub). Similarly, HHS expects that States will be in
various stages of the Exchange-development lifecycle when Blueprints are submitted. Many State
Exchange-development activities are likely to occur in 2013. HHS will utilize Conditional Approval for
State-based Exchanges and Partnership States whose Exchange establishment is not complete at the
time of Blueprint submission.