A Closer Look at the Oversight of State-based Marketplaces
The 17 states, and the District of Columbia, electing to operate a State-based Marketplace (SBM) are subject to comprehensive oversight from a varied set of federal and state agencies, committees, and regulators. Ongoing reporting, site visits, and auditing spans the full range of SBM functions, including eligibility and enrollment, data security, consumer privacy, financial transactions, business operations, grant monitoring, budget, consumer assistance, and marketplace personnel policies.
For SBM states to cooperate and assist with the numerous inquiries and audits related to their operations, they must utilize staff resources from all marketplace departments. SBMs also frequently need to rely on other agencies such as IT, data, policy, legal, and Medicaid in order to meet all components of an oversight request. In addition to this staff time, SBMs also typically have one staff member who is responsible for coordinating with the auditors and obtaining all the necessary information and data for compliance.
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For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
