This report analyzes how five characteristics of health
insurance exchanges might address particular rural
Standards requiring that exchanges contract with
Qualified Health Plans (QHPs) to provide an "optimal
combination of choice, value, quality, and service" (see
examples within California and Rhode Island statutes)
could result in improved insurance markets in rural
Two states (Oregon and Hawaii) require geographic
diversity among members of the exchange governing boards.
Four states (Massachusetts, Oregon, Vermont, and
Utah) require community-based activities to facilitate
consumer enrollment into QHPs through the exchange;
Massachusetts specifically requires outreach activities
that target persons "who may require individualized
support due to geography."
All statutes and executive orders that we analyzed
incorporate the network adequacy standards as stated in
the ACA and subsequent regulations issued by CMS, which
could require contracting with rural providers.