Leslie Norwalk is administrator for the Centers for Medicare and Medicaid Services, which directs day-to-day operations of Medicare, Medicaid, Child Health Insurance Programs, Survey and Certification of health care facilities and other federal health care initiatives.

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The states can choose to be responsible for plan management, meaning they will be charge of qualified health insurance plan certification and reinsurance, data collection and basic supervision.

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Two months later, the Office of the National Coordinator for Health Information Technology, which is responsible for EHR certification, issued a different set of rules, stating that hospitals have to certify their EHRs on 24 measures to meet requirements.

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Groups that receive grants from that allocation may try to stretch it by using volunteers to act as navigators, but some are already wondering if it is worth the trouble to apply in the face of a state bill requiring separate certification, said Adam Linker of the North Carolina Justice Center's Health Access Coalition.

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