health insurance exchange workgroup august 29, 2012
DESCRIPTION
Health Insurance Exchange Workgroup August 29, 2012. Presented by: Tom Donovan, Deputy Director, Insurance Valerie Fend-Boehm, Project Staff. Agenda. Subcommittee Support CCIIO Blueprint Review CCIIO Guidance Review. Subcommittee Support. Introduction Support Research & resource support - PowerPoint PPT PresentationTRANSCRIPT
Health Insurance Exchange Work Group 1
Health Insurance ExchangeWorkgroup
August 29, 2012
Presented by:Tom Donovan, Deputy Director, InsuranceValerie Fend-Boehm, Project Staff
8/29/2012
Health Insurance Exchange Work Group 2
Agenda1. Subcommittee Support2. CCIIO Blueprint Review3. CCIIO Guidance Review
8/29/2012
Health Insurance Exchange Work Group 3
Subcommittee SupportIntroductionSupport◦Research & resource support◦Attend sub-committee meetings◦Assist with other needs/requests
Weekly Resource List◦Evolving Tool◦For you!
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Health Insurance Exchange Work Group 4
Overview of Blueprint for Approval of Affordable State-based and State Partnership Insurance Exchanges
8/29/2012
Health Insurance Exchange Work Group 5
Blueprint ReviewWhat?◦ Identifies options for State flexibility in the
development of Exchanges.◦Outlines specific requirements to apply for
approval as a State Based Exchange or Federally-facilitated Partnership Exchange.
8/29/2012
Health Insurance Exchange Work Group 6
Blueprint Review
8/29/2012
Flexible Exchange Options for States
Health Insurance Exchange Work Group 7
Blueprint ReviewExchange Approval Timeline for Plan Year
2014
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Health Insurance Exchange Work Group 8
Blueprint ReviewTransition Timeline
8/29/2012
Plan Year
Blueprint Due Operational Coverage Begins
2014 November 16, 2012 October 01, 2013 January 01, 2014
2015 November 18, 2013 October 01, 2014 January 01, 2015
2016 November 18, 2014 October 01, 2015 January 01, 2016
Health Insurance Exchange Work Group 9
Blueprint ReviewBlueprint Approval
8/29/2012
Full Approval Conditional Approval
Meet all approval requirements on January 1, 2013
Do not meet all requirements, but are making “significant progress”
Completed all Exchange activities, supporting documentation & operational readiness evaluation
Defined milestone & dates for operational readiness reviews
Exchange operational by 10/01/2013
Exchange operational by 10/01/2013
Health Insurance Exchange Work Group 10
Blueprint ReviewDeclaration Letter:◦Part I of Application◦Required for SBE, FFE-P, and FFE (with
reinsurance) States; encouraged for FFE.
8/29/2012
Health Insurance Exchange Work Group 11
Blueprint ReviewAssumptions in the Absence of an Declaration Letter◦ The State will not administer it own reinsurance program;◦ “The State’s small group and individual markets will be
merged in the Federally-facilitated exchange only if the current individual and small-group markets are merged. Is a State does not merge the individual and small-group-market risk pools, the SHOP will permit each qualified employee to enroll only in QHPs in the small-group market; and
◦ The State’s current definition of “small-group” employer (e.g. “up to 50” or “up to 100” employees) will be followed, while the method of determining employer size will be based on full-time equivalent employees consistent with other Affordable Care Act policies.”
8/29/2012
Health Insurance Exchange Work Group 12
Blueprint ReviewApplication
8/2/2012
Health Insurance Exchange Work Group 13
Blueprint ReviewExchange Blueprint submission includes:◦Attestations of completion of Exchange
Activities or the dates of expected completion◦Supporting documentation, including
descriptions of processes and strategies◦Attachment of reference files and Testing
Files, including results of State testing, HHS-developed test scenario testing, and Independent Verification and Validation (IV&V) testing
8/2/2012
Health Insurance Exchange Work Group 14
Blueprint ReviewApplication
8/29/2012
Health Insurance Exchange Work Group 15
Blueprint Review
8/29/2012
Health Insurance Exchange Work Group 16
Blueprint ReviewMore Information?◦CCIIO Blueprint ‘Deep-Dive’ Webinars
Questions?
8/29/2012
Health Insurance Exchange Work Group 17
Overview of General Guidance on Federally-facilitated Exchanges
8/29/2012
Health Insurance Exchange Work Group 18
Guidance ReviewWhat?◦Outlines HHS’s approach to implementing an
FFE in a state without a SBE, including: How States can partner with HHS to implement
selected functions in a FFE (Partnership) Key policies organized by Exchange function, and How HHS will consult with a variety of stakeholder
to implement an FFE.
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Health Insurance Exchange Work Group 19
Guidance ReviewSection I: BackgroundSection II: State Partnership in an FFE
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Health Insurance Exchange Work Group 20
Guidance ReviewSection III: Approach to Key Exchange
Functions in a Federally-facilitated Exchange◦Plan Management (pg. 8)
◦Accreditation and Quality Reporting (pg. 11)
◦Eligibility and Enrollment (pg. 12)
◦Consumer Support & Outreach (pg. 15)
◦Federally Facilitated-SHOP (pg. 16)
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Health Insurance Exchange Work Group 21
Guidance ReviewSection IV: Stakeholder Input◦“HHS will work closely with local stakeholders
to implement each FFE, including in State where a Partnership is operating. HHS is committed to creating a transparent process for FFE development in each State, and will seek input from stakeholders and provide technical assistance to those stakeholders working with an FFE.”
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Health Insurance Exchange Work Group 22
Guidance ReviewQuestions
8/29/2012
Health Insurance Exchange Work Group 23
Thank you
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