Insurance Exchanges
Insurance exchanges will have a vital role in the marketplace, helping consumers shop for, understand, and purchase coverage. States can also use exchanges to shape the quality and cost of plans.
The ACA calls for the creation of American Health Benefit Exchanges, which are expected to be the source of health insurance coverage for millions of Americans. Primary responsibility for establishing exchanges rests with the states, although the federal government will step in to create them in states that opt out. States that decide to establish an exchange will need to determine policy goals and governance structure; develop enrollment systems and IT infrastructure; and adopt plan rating, billing and other systems.
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New York
We are developing the Navigator Training for NYHBE. I am very interested in connecting up with other curriculum developers to establish a community of practice for sharing and developing best practice for preparing navigators. If you are interested please contact me at stephenjrussell@maximus.com. I recognize there maybe challenges in working together but i am open to give it a try. We are not waiting for federal model/standards to come out.
With exchange open enrollment set to begin October 1, 2013, the federal government—now responsible for at least partial marketplace facilitation in 32 states—has perhaps the largest role to play in meeting the deadline. Ongoing discussions on Medicaid expansion and the premium assistance option have added to uncertainty about the size and composition of the exchange markets. Meanwhile, this unpredictability is challenging insurers as they work to design and competitively price qualified health plans, with consumer choice and plan affordability at stake.
This webinar will cover the following topics:
-the progress of exchange implementation across the states and the implications for coverage
-the latest on the development of federally-facilitated and partnership marketplaces, straight from CCIIO
-how Medicaid expansion decisions will affect the exchange market
- the response of health insurers to the challenges of the new marketplace
Date & Time:
May 7, 2013
1:30 - 3:00 p.m. EDT
Speakers:
Rosemarie Day
Day Health Strategies & McKinsey's Center for U.S. Health System Reform
Lourdes Grindal-Miller
Acting Director, Division of Plan Management, CCIIO
Mandy Cohen
Senior Technical Advisor, CMS
Scott Keefer
Vice President, Policy and Legislative Affairs, Blue Cross and Blue Shield of Minnesota
Register at: http://nihcm.org/conferences-and-webinars/event-registration?
District of Columbia
In the April issue of Health Affairs, authors of a review of Dutch and Swiss insurance exchanges report on their findings, including potential lessons for exchanges in the US. The lessons include careful risk adjustment mechanisms and attention to why some individuals do not enroll in coverage.
Ohio
Does anyone have a handy source for states which will be offering coverage via exchanges to the under 50 versus the under 100 market? Are these categories driven with the state by state decisions on implementation of the community rating rules?
Virginia
hello John-
I have compiled a chart showing what states consider "small businesses" for purposes of participation in the SHOP exhange in 2014 and 2015. I will be glad to forward you my findings ibut cannot post it on the site. Please send me an email at : antonia.feldman@towerswatson.com
Antonia
Alabama
Will states and the federal government review every plan for certification or will they just be doing spot checking of plans to ensure compliance with rules? That seems like a lot of plans to review.
District of Columbia
Hi James,
The quick answer is essentially: yes. All products sold in any exchange will need to be certified as qualified health plans (QHPs). With state-based Exchanges, the traditional regulatory roles of state departments of insurance that involve insurance plan certification will remain largely unchanged, and thus require minimal federal oversight. In fact, this is nothing new to them—they do it all the time for all sorts of insurance products sold in their states. With State Partnership Exchanges, there will some shared certification duties between states and the feds, depending on the elements of the individual state's specific partnership agreement. In FFE states, CMS will be handling all of the QHP review and certification duties.
It's also worth noting from CMS's recent online guidance (accessible here: http://cciio.cms.gov/programs/marketreforms/Compliance/index.html), that in states unwilling or unable to enforce the ACA's insurance provisions, either for political reasons or because their state laws do not specifically allow for enforcement of federal law (Alabama is on this list), CMS will "…directly enforce the relevant provisions in the state with respect to health insurance issuers in the group and individual markets."
Perhaps more to your point though, of the dozens of plan certification elements required of QHPs to be sold in exchanges, some states may indeed chose to accept attestations for certain elements initially, rather than checking all of the individual elements of each plan before granting QHP certification. Standards like network adequacy and appointment wait times are commonly approved by attestation and then spot checked by “secret shoppers” later on down the road.
Hope this was helpful!
Mark Dorley, HealthReformGPS Project
George Washington University
Alabama
Thanks Mark! Much appreciated.
Maryland
I've read to notice but it’s clear as mud as to what will happen with FFE SHOP exchanges. I take it the FFE Exchanges will operate as normal purchasing exchanges and not be offering advanced services such as multiple plan offering within one employer and aggregation of premium across offerings. The smaller carriers out there who are serving their markets need clear guidance from Washington and not the Beltway babble they are getting if this thing is to work. Regulators need to realize that not everyone has platoons of lawyers to interpreter their pronouncement. I understand the reason for the delay as eligibility and premium tracking is one of the most difficult activities a carrier or Exchange faces.
California
The proposed rule released by HHS on 3/1 allows SHOP exchanges to (a) only offer employer choice plan and (b) not implement the premium aggregation function in 2014.
For State-based Exchanges that take this approach (and FFE), does this automatically imply that issuers will be required to bill the groups directly and collect payments? Or will the SHOPs be still required to own group billing and pass payments to the issuers (although aggregation of premiums will not be necessary)?
District of Columbia
Hi Rohit-A user in this discussion had a similar question: http://statereforum.org/topic/392. It is not clear from the guidance- but they are asking for comment on those two issues, so further guidance on this may be forthcoming.
District of Columbia
GW's HealthReformGPS project is out today with a new piece on the federally-facilitated Exchanges. It begins with a summary of federal policy guidance on health insurance Exchanges issued to date, and then presents in its entirety an interview with CCIIO Director Gary Cohen, conducted by Professor Sara Rosenbaum of GW, on January 29, 2103. The piece concludes with some observations about key issues that will arise as implementation of the federal Exchange proceeds. Hope you find it helpful.
-Mark Dorley
New York
Do the Federal regulations for the Exchange allow the sharing of personally identifiable coverage data with Navigators/ In Person Assisters to faciliate assistance with renewals and outreach ?
If so have any states made provisions for this type of data access and sharing ?
District of Columbia
Hi John- Based on our reading of the final exchange regulation, sections 155.210 and 155.260, it does look like navigators will have access to personally identifiable information. The final rule requires exchanges to develop training standards for navigators and to set privacy and security standards that navigators must follow.
You can read more here: https://www.federalregister.gov/articles/2012/03/27/2012-6125/patient-pr...
Pennsylvania
Hi Rachel and John -- I wanted to add that states have leveraged data sharing strategies to support enrollment in public benefits programs for some time, and we think it is a very important strategy to pursue when implementing health care reform.
This report from the National Council on Aging talks about how HIPAA regulations allow for data sharing with state contractors (who could be community-based organizations) to complete outreach and education, under specific data sharing conditions: http://www.ncoa.org/assets/files/pdf/center-for-benefits/Data-Sharing-Is...
Also, here is an example of a very successful data-sharing project to increase access to SNAP for senior households completed by non-profit Benefits Data Trust, in partnership with Pennsylvania and the U.S. Department of Agriculture, that may provide useful strategies for Navigator/IPA programs: http://www.bdtrust.org/uploads/medium/file/235/2012_BenePhilly_Final_Rep...
Let me know if you have any questions.
New York
Thank you for the comments. So it appears that the Exchange Privacy regs allow Navigators to have access to personnally identifiable data and there is precedence for sharing this type of data to foster enrollment. The question is then whether the Exchange Technology is being built to accomodate this type of data sharing. Perhaps the technology folks can enlighten us on this point.
District of Columbia
On November 14, 2012, 29 republican governors submitted a letter to President Obama including a number of questions relating to exchanges and the Medicaid expansion.
District of Columbia
Health insurance exchanges are the centerpiece of the private health insurance reforms included in the Patient Protection and Affordable Care Act. As of May 2012, 13 states, together with the District of Columbia, had taken legal action to establish exchanges, through legislation or executive order. State implementing laws are essential to the translation of broad federal policies into specific state and market practices. Overall, the laws in the 14 jurisdictions vary, but they tend to show a common approach of according exchanges much flexibility in how they will operate and what standards they will apply to the insurance products sold. In all states, these "threshold policies" will be followed by policy decisions, expressed through regulations, guidelines, and health plan contracting and performance standards.
Arizona
UPDATED RESEARCH: Estimating Eligibility For and Participation in the ACA Exchanges in Arizona
District of Columbia
A state official asked us where to find the latest state developments on exchanges. If you’re in the same boat, we recently updated some of our materials that you may find helpful.
State Refor(u)m’s establishment grant chart summarizes the grant narratives and details how states plan to use their funds from the federal government to build and develop an exchange: http://www.statereforum.org/establishmentgrants
Our state legislation and executive order chart analyzes these documents in over a dozen domains:
http://www.statereforum.org/sites/default/files/leg_chart_4_25.xls
Finally, the State Refor(u)m blog, State of Implementation, contains frequent exchange-related posts, which you can find here: http://www.statereforum.org/blog.
Check out our most recent blog posts:
Exchange financing: http://www.statereforum.org/blog/exchange-sustainability-puzzle
Active purchasing: http://www.statereforum.org/blog/Six-States-Give-Green-Light-to-Active-P...
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