On March 12, 2012, CMS issued a final rule that provides a framework to assist states in establishing Affordable Health Insurance Exchanges (Exchanges)— a crucial element to the implementation of health reform under the Patient Protection and Affordable Care Act (ACA). The final rule finalizes two previously issued Notices of Proposed Rule Making (NPRM): (i) a NPRM issued on July 15, 2011 addressing proposed state requirements and standards for establishing Exchanges and (ii) a NPRM issued on August 17, 2011 regarding proposed standards for eligibility and enrollment standards in qualified health plans through the Exchange. According to CMS, Exchanges, which will be operational starting in 2014, are “one-stop marketplaces” that will enable consumers and small businesses to select quality, affordable private health insurance plans that fit their health needs. They will perform a variety of functions, including certifying health plans to be offered in the Exchange, operating a website that will allow consumers to compare qualified health plans, operating a toll-free hotline for consumers, determining Exchange eligibility, and facilitating enrollment. ACA contains provisions that, among other things, give states the opportunity to establish, operate, and enforce Exchanges.