While HHS and CMS have come forth with some answers to the myriad lingering questions about Health Insurance Exchanges, it doesn’t change the fact that Jan. 1, 2014 remains a tight start-up deadline for states to meet.

As mandated by the Patient Protection and Affordable Care Act, the exchanges must allow time for consumers to qualify and enroll prior to the start date. It is a timeline that is putting tremendous pressure on states, acknowledges Bobbie Wilbur, co-director at Oakland, Calif.-based Social Interest Solutions.

“One of the most significant challenges is that this must be done in the next 600 days,” she said. “The coordination and technical integration across three or four state agencies and the federal government means more integration than ever before. Further, the entire business process is changing and expanding so that it covers a breadth of coverage options that results in both the change in technology and as well as the complexity of the program.”

State officials in charge of HIX implementation have complained that the timeline is simply too short, Wilbur said, explaining that “in order to have open enrollment starting on Oct. 1, 2013, the plan selection and plan management components must be operational at least by July 1, 2013. This is a very compressed time frame for a project of this complexity.”

Indeed, the challenges in HIX stem from the intricate procedures, not on the technology end, says David Barth, senior director of strategic development for Wethersfield, Conn.-based Post-n-Track.

“It is the integration issue for HIXs that is tricky,” he said. “It is e-commerce, but specific to health insurance. It is a totally new model. The best analogy I can make is having a third party go shopping with you in a store. While you review the merchandise, that third party is busy checking all the prices. Then you have to explain to the vendor how to present all these different products to people – the vendor has to let the people shop around and identify themselves in order to qualify for rebates or government assistance.

On top of that you have security and privacy concerns through HIPAA. This is a very complex program.”

From a technology standpoint, the implementation should be relatively easy, Barth said.

“We are a cloud technology platform and while we’re not yet sure how this will apply to the HIX, we don’t anticipate ‘reinventing the wheel’ for this program,” he said. “We have the infrastructure necessary and are already dealing with sophisticated multi-enterprise configurations.”

Linda Skinner, director of Health Care Innovation Infrastructure Management for the State of Arizona, agrees that it is the timelines, not the technology that is the difficult part.

“These exchanges, in the format required by the ACA, are new and required in every state,” she said. “The availability of suitable vendors, the pricing of their products and their ability to implement quickly and accurately are areas of concern that we won’t have the answers to until we go through the procurement and development processes.”