Like the past few weeks, most exchange developments occurred on the Hill. This week, CMS Deputy Chief Information Officer Henry Chao testified on Tuesday in front of the House Energy and Commerce Subcommittee on Oversight and Investigations that 30 to 40 percent of the technology systems that support HealthCare.gov and State-based Exchanges still need to be built. Specifically, contractors are still building the accounting and payment systems that will be used to pay tax credits and reconcile enrollment and payment data with insurers in 2014. 

As for improvements to HealthCare.gov, CMS announced that it turned on the functionality to allow Direct Enrollment, a process that allows HealthCare.gov to determine subsidies for applicants that then shop for and enroll in coverage directly through a private insurer or web broker. However, since the announcement various insurers have said they will need additional time to test the Direct Enrollment interface with CMS before letting consumers utilize it. The Direct Enrollment process still relies on many services performed by HealthCare.gov, such as the account creation process, identity proofing, APTC determination and sending the final 834 enrollment file to carriers. As for which web brokers might offer Direct Enrollment in the near future, the Delaware Department of Insurance has posted a partial list of entities that have signed web broker agreements with CMS.

CMS also said it fixed two-thirds of the high priority problems with the 834 enrollment files sent by HealthCare.gov to insurers. As the end of the month draws nearer, CMS had said it still expects to launch the Spanish language online application for HealthCare.gov by November 30. And on Friday, one of the top advisors helping fix HealthCare.gov, Jeff Zients, said that due to hardware additions and software modifications, HealthCare.gov will be able to handle 50,000 concurrent users by the end of the month. However, one topic that has been absent from recent CMS updates is the status of the FF-SHOP. Exchange watchers expected to hear an update on the FF-SHOP when Gary Cohen, director of the Center for Consumer Information and Insurance Oversight appeared before the U.S. Senate Small Business and Entrepreneurship Committee this week, but the topic never came up.

Moving into the states, on Tuesday, the board for Your Health Idaho rejected a request by executive director Amy Dowd to hire an insurance policy analyst and create an information technology position within the exchange. Instead, the board favored including the IT position in a forthcoming professional services contract, which is tentatively budgeted by the exchange to run between $1 and 3 million.

At their board meeting, the board for Covered California chose to transition Covered California to using the Federal Data Services Hub to verify an applicant’s identity based on correct answers to security questions, which are drawn from an applicants’ credit history, residential history, and other sources. Currently, Covered California’s online application accepts an electronic signature from the applicant “attesting to his/her identity, under the penalty of perjury.” The board also chose to delay until January 2015 what will be a closely-watched decision on how to offer and provide the pediatric dental benefit. The board also reviewed progress on the exchange’s preparation for its forthcoming Navigator program. The Navigator grant application is scheduled to be released on February 3, 2014, with $5 million currently set aside for grant awards. Covered California also reported that it was receiving nearly 10,000 applications per day and that as of November 19, 79,891 Californians had selected a health plan. Covered California’s update included detailed information on the private insurance plans its users selected, with the majority of applicants selecting plans offered by Anthem Blue Cross of California or Blue Shield of California.

In Washington, the state's health exchange is seeking a $92 million federal grant to pay for technological improvements and other consulting services next year, including $51 million for the upgrading of the Healthplanfinder technology currently employed on the site. In discussions during the exchange board’s meeting on Wednesday, Chief Financial Officer Bob Nakahara warned that the $40 million budget projected for 2015 could require steep cutbacks in advertising and marketing, which could in turn reduce enrollment. The board approved a spending level of approximately $65 million for 2014.

Also to the west, this week Rocky King, executive director for Cover Oregon, answered questions from state lawmakers over Cover Oregon’s rocky launch and efforts to fix the online web portal. A presentation to lawmakers showed that the entire Cover Oregon system, except for SHOP and Tribal registration, is scheduled to be operational by December 16. In the meantime, Cover Oregon now has an online service that allows registered insurance agents and in-person assistors to determine whether an applicant is eligible for Medicaid or APTC. Agents and in-person assistors are scheduled to gain access to a special web portal to enroll applicants online beginning on December 9. The online application and enrollment web portal is scheduled to be open to the general public on December 16. Applicants that want to have coverage beginning on January 1 need to submit their application to Cover Oregon by December 4 and select their plan by December 15. As of November 18, Cover Oregon has received 24,486 applications in paper and electronic format, and has performed 1,371 eligibility determinations.