Language/Disability Application Access
The diversity among the millions who will become eligible for state health subsidy programs will be substantial. States need to ensure that enrollment tools and communications are accessible and understandable to the broad range of individuals applying.
*Milestone details:
*Full name: Develop and test applications and other communications that are accessible to people with limited English proficiency, low literacy, physical disabilities, or who lack computer or phone access.
*Relevance to the ACA:
The ACA requires states to establish multiple application methods and to ensure accessibility for the diverse range of individuals who will be applying. Provisions relevant to accessible applications and communications include:
§1001 – Requirement that insurers provide an accurate summary of benefits and coverage, in a format understandable by consumers.
§1002 – Grants to establish or expand offices of health insurance consumer assistance or health insurance ombudsman programs.
§1311 – Health plans must submit information about their plans in “plain language” – a language that would be understandable by the intended audience; the Secretaries of HHS and Labor will provide guidance on plain language. An Exchange will establish a program to award grants to support navigators who will engage in public education, disseminate information, and assist in enrollment.
§1413 – Creation of a single application form by the Secretary or a state for all health subsidy programs, structured for ease of understandability by consumers, taking into account the diverse characteristics of those who will be applying for coverage and allowing for submission through multiple methods. Requirement that consumers can use this form to apply online, in person, by mail, or by telephone.
§2201 – States will establish outreach and enrollment assistance to vulnerable and underserved populations.
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Illinois
As we are comparing the FEDVIP Vision Plan with the Illinois CHIP Vision Plan, we have noticed that there is no mention of whether the FEDVIP Vision plan covers artificial eyes. It clearly states in the "Exceptions" section that prosthetics are not covered. Does anyone know if FEDVIP Vision Plan covers artificial eyes, when medically necessary or if it is the medical plan that would pick up payment for such a service through the prosthetics section. Interestingly enough, the Illinois CHIP Vision plan does mention it as follows: “Custom-made artificial eyes are subject to prior approval and are covered only when the patient is unable to wear a stock plastic eye. All prior approval requests must include information as to why a stock artificial eye is not appropriate to meet the patient's need”.
California
Hi Sheba and Kate -
Thanks for the feedback. We will be refining and updating this document later this year so we will incorporate your suggestions. For this first version we largely followed the guidance of the Summary of Benefits and Coverage Final Rule to outline key services but in future iterations, we may need to consider additional services outlined in ACA/EHB guidance. We would appreciate any other comments on how states are approaching this.
Alana
Nebraska
Agreed, very useful document. One thing I have seen in several consumer choice and planning documents is the lack of information and/or planning to allow consumers to select an eligible Qualified Dental Plan as provided for in ACA, which will provide the benefits for the essential pediatric dental portion of the required essential benefits package. Any insight or thoughts?
Illinois
Alana, thanks for this very useful document. I noticed, as I have noticed in other similar EHB comparisons, that covered services relating to dialysis and chemotherapy are usually not mentioned. Is there a particular reason for this? Cancer and Kidney Disease are included in "Disease Management Program", yet only"radiation" is mentioned in the covered services. Thanks.
California
Companion spreadsheet to Consumer Choice of Health Plan Decision Support Rules.
California
Through the Helping Vulnerable Consumers in the Exchange Project, the Pacific Business Group on Health (PBGH) has created a first installment of plan choice decision support rules that exchanges can use to build their consumer choice software requirements. These rules are informed by plan choice research performed by decision science experts at Columbia and Penn Universities. PBGH has also included a companion document that provides additional details about the information required of health plans to support consumers in making plan choices. These documents are intended for staff at the exchanges who are responsible for plan choice technical requirements. This is the first in a series of installments and updates that aim to support consumers in selecting a plan that best meets their needs.
If you would like additional information, please contact Ted von Glahn at tglahn@pbgh.org.
California
As 2014 looms closer, a key concern is that many of the insurance exchanges’ consumers are likely to make the “wrong” plan choice when selecting a health plan on the exchange. State exchanges can help users choose a plan that meets their needs for affordable, quality coverage, by deploying plan choice decision aids and assistance that are grounded in an evidence-base about how people make good choices.
Through the Helping Vulnerable Consumers in the Exchange Project, the Pacific Business Group on Health (PBGH) is creating plan choice decision support rules that exchanges can use to build their consumer choice software. These rules are based on plan choice research performed by human decision experts at Columbia, Penn and Stanford Universities, designed to answer a number of questions like:
Do automatic defaults, which simplify the choice process, lead to better plan selections?
How should premium subsidy information be presented to support choice?
Do people make better choices when using cost at time of care summary amounts based on utilization profiles?
What techniques would help people properly use health plan quality ratings when making choices?
The project team will produce the following deliverables for exchanges between February and September 2012:
*Evidence-based guidance about the information consumers need and how that information should be presented to support plan choice decisions;
*Translation of evidence-based guidance into business requirements and rules that exchanges will embed into their plan choice decision-support software;
*Health plan data requirements that exchanges can use when asking health plans to submit data to support consumer decision-making.
You can find early examples of these deliverables in the attached. Please contact Alana Ketchel at PBGH (aketchel@pbgh.org) for more information.
Alabama
This is a report of a focus group study that was conducted with current and former CHIP and Medicaid enrollees.
California
This report discusses a number of goals related to eligibility and enrollment.
Access the report:
http://www.statereforum.org/sites/default/files/md_finalreportentryworkg...