Exchange Plan Selection
A strategy for determining which health plans will be offered in the Exchange helps the state assure that plan selection will be aligned with overall goals for the Exchange and will ensure a competitive, consumer-friendly marketplace.
*Milestone details:
*Full name: Define the health plan selection strategy of the Exchange.
*Relevance to the ACA:
The ACA specifies that states may certify plans that meet the Secretary’s criteria for certification and that the Exchange determines are in the interest of “qualified individuals and employers.” This allows the Exchange additional discretion over the plans it selects to offer. Sections relevant to plan selection include:
§1311 - Requires Exchanges to implement procedures for certifying, recertifying and decertifying health plans in the Exchange.
§1312 - Requires insurers to create a single risk pool inside and outside the Exchange for each market (individual and small group). Provides state flexibility to merge these markets, continue state benefit requirements, and continue operating a market outside the Exchange.
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Massachusetts
Want to see what plans have put in an application to register as a QHP - is this information made public anywhere? Thanks!
District of Columbia
I have not seen this made public yet. Certain carriers have publicly announced their decision on a case-by-case basis, but I don't think HHS will be releasing this information until they review all applications for approval. They were due to HHS on Friday, May 3. Here's a Politico account of the situation from May 8. If there's any update, I'm also interested.
HHS SILENT ON FEDERAL EXCHANGE INTEREST FOR NOW — Last Friday night was the deadline for insurers to submit applications to sell on federal-run exchanges, but HHS isn’t ready yet to say how many have applied. The department is still reviewing the submissions, an HHS official said, so we’ll have to wait a little longer to know for sure how many applied and how much competition there will be within the federal exchange states in 2014. The latest update we have is from two weeks ago, when CCIIO Director Gary Cohen said about 140 insurers had started the application process. “The reports that I’ve seen were very encouraged by the number of issuers in each state, which is really the most important thing, that there be good competition in each state,” Cohen said April 24.
District of Columbia
Thanks Claire! I would have answered in the exact same way, and I am hanging my hat on that same "140" number from Politico.
New Jersey
The team at the Georgetown University Health Policy Institute, as part of its participation in the State Health Reform Assistance Network (State Network), developed updated checklists to help state departments of insurance review qualified health plan solicitations for conformity with ACA requirements. The updated checklists along with a presentation describing the ACA insurance market reforms can be found at the link provided here.
The State Network is a program of the Robert Wood Johnson Foundation helping a select group of states implement the coverage expansion provisions of the ACA.
New York
Has any state other than California released the specifics of it's plan designs for state exchange plans? I'm looking specifically for Rx levels but curious in general as well.
District of Columbia
Hi Jon- Connecticut has released their standard plan designs. You can find those here: http://www.statereforum.org/sites/default/files/ct_board_approved_standa...
New York
Thanks for responding so quickly Rachel! So is it safe to say that just California and Connecticut have released their plan designs?
District of Columbia
I can't say with certainty they are the only two- but they are certainly two of the states moving pretty quickly on their QHP certification processes. We are collecting everything we can find about exchange plan selection in states so keep checking back to our documents page where we'll post things as we find them. http://www.statereforum.org/documents?indicator=All&topic=387&document_t...
Washington
This site might help some
http://www.avalerehealth.net/news/2012-10-01_EHB_Formulary_Analysis/EHB_...
Wisconsin
Very Useful Site: http://www.statehealthfacts.org/comparereport.jsp?rep=156&cat=17&rgnhl=1
California
So far I'm aware of 4 state-based exchanges have done so: California, Massachusetts, Vermont and Connecticut.
District of Columbia
From looking at RFPs and other documents related to QHP certification, we put together this slide of relevant dates related to certification for eight states and DC. Feel free to download the slide and use it. If you have information on other states, please share it with us!
District of Columbia
We've updated our slide to include a few more states. Please share if you have information on more states!
District of Columbia
We've now updated the slide to include form and rate filing dates.
California
We have just gone through round of one of comments from the public on our model contract for our QHPs. Feel free to let us know what you think. Thanks.
Andrea Rosen
Interim Health Plan Management Director
District of Columbia
This document outlines requirements for QHPs in Maryland's exchange.
District of Columbia
On December 13, 2012, Connecticut released a solicitation for QHPs in the individual and SHOP exchanges. Plans must notify the exchange if their intent by Jan 4 if they wish to participate.
District of Columbia
Approved by Delaware Health Care Commission (HCC) November 1, 2012. If anyone from Delaware knows more about the process going forward, please share!
District of Columbia
Is there a list of deadlines for proposals for State RFPs related to QHPs in the Exchanges?
District of Columbia
Hi Ted- Thanks for your question. We do have a few state QHP RFPs in this discussion below- CA, VT, DC and OR. Proposals for VT are due Jan 8, 2013 and proposals for CA are due Jan 15, 2013. As we get more RFPs, we will certainly post them here.
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