Arkansas PPT (Health Insurance Exchanges)
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Transcript of Arkansas PPT (Health Insurance Exchanges)
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Federally-facilitated Exchange
Partnership Planning in Arkansas:
Where Weve Been; Where We Are Now; andLessons Learned
Cynthia Crone, APNArkansas Insurance Department
Presented to
Idaho Health Insurance ExchangeWorking GroupOctober 9, 2012
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Low Per Capita Income
Poor Health Status Indicators
Large and Growing Percentage of Uninsured
Medicaid Deficit Expected in 2013
Health Agency Leaders Working Together toImprove Health System
Arkansas Landscape
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Arkansas Health System Improvements
Payment and Quality Transformation using Evidence-Based Episodes of Care PCMC Model
Workforce
Health Information Technology
Health Benefits Exchange
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ACA and Arkansas Political Landscape
Popular Governor
Democrats are Majority in Legislature, Growing Number
of Republicans
Vocal, Active TEA Party Republicans Opposed to ACA
and therefore to Exchanges
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Exchange Planning
Arkansas Insurance Department is Lead Agency
Commissioner is Governor Appointee andPlanning Authority
Funding to Date
Exchange Planning
Level One Cooperative Agreements (2)
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How Many Will Be Affected?
An estimated 572,000 Arkansans will be eligible forExchange coverage beginning January 1, 2014.
It is conservatively estimated that: 328,000 more nonelderly Arkansans will enroll (resulting
in a 60% decrease in uninsured post-ACA). There will be a $615 million reduction in uncompensated
care among nonelderly (a 68% change post ACA). There will be $478 million in federal subsidies provided for
Arkansans to purchase insurance.
Source: State Progress Toward Health Reform Implementation: Slower Moving StatesHave Much to Gain, Timely Analysis of Immediate Health Policy Issues, January 2012Urban Institute analysis, HIPSM
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As Is (Pre-ACA)(ACHI, 2012)
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2014 (Post ACA)(ACHI, 2012)
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Development of Partnership Model
Arkansas did not obtain authority for State Exchange - 2011
Arkansas did not seek Level One funding - September - 2011
Partnership Option Announced by CCIIO - September 2011
Exchange Planning Steering Committee recommended thatplanning for a State Exchange end - November 2011
Obtained Governors approval to explore Partnership Modeland apply for Level One Funding - December, 2011
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Arkansas is Planning
Full Partnership Model
Plan Management
Consumer Assistance
MedicaidFFE Integration
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Level One Funding and Waiting
First Level One funding award received February2012
Required to obtain Legislative Approval for Spending
While waiting Exchange Planning Grant No Cost Extension kept small staff
operating
Designed Stakeholder Engagement Process
Designed Contractor/Staff Communication Process Implemented Advanced Procurement and Hiring Activities
Level One Appropriation obtained April 20, 2012
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Stakeholder InclusionOperational Model
Planning Staff &
AdvisoryCommittees
Research /
Alternatives
Analysis
Steering Committee
FinalRecommendation
to Commissioner
Advisory Committees
DevelopRecommendations
with Alternatives
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Steering Committee
The Steering Committee meets once monthly and includes
representation of the following:
Insurance Department (2)
Department of Human Services (2)
Arkansas Health Agency Leaders
Department of Finance & Administration
Advisory Committee CoChairs (6)
State Legislature (2)
Governors Office
Stakeholders At Large (3)
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Topic Calendars
OctMay June July August Sept
Essential
Health
Benefits
Active Purchaser
vs. Open Market
Active Purchaser
vs. Open Market
Network
Adequacy,
Market
Standard andRisk Pool
Definition
QHP Elements
Application
Submission and
Transmission ofData Elements
QHP
Application &
Certification
Format andContent
OctMay June July August Sept
IPA EligibilityIPA Certification
& Recertification
IPA Training
Options
IPA Application
& Application
Review
IPA Program
Funding
IPAPerformance
Metrics
Nov
IPA Ongoing
Monitoring
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Consumer Assistance
In-Person Assisters (IPAs)
Categories
- Navigators
- Enrollment Assisters
- Licensed agents and brokers (producers)
Arkansas Insurance Department will:
- Certify, recertify, decertify individual IPAs
- Oversee IPA training and performance
- Contract with IPA entities to facilitate enrollment and post-
enrollment complaint resolution as needed
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Consumer Assistance
Outreach and Education
Outreach Education
Two Phases Planned for 2012-2013
Phase IGeneral ACA/Exchange Education
Phase IIMove Eligible Residents toward Enrollment
IPA Specialists through Home Town Health
Complaint Resolution
FFE Eligibility/Enrollment AID Consumer Services Division
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Current Outreach/Education - Phase I
Interagency ContractsUAMS
Opinion Poll to guide messaging for Phase I
Focus Groups to assist with Naming/Branding
Speakers Bureau
Initial Message Development/Media Buys
U of A Partners for Inclusive Communities
County Meetings Quarterly Updates
Stakeholder Summit
Staff/Consultants - IPA Outreach
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In Person Assister (IPA) Entities
AID will contract with community-based IPA entitiesthat will engage certified IPAs
We estimate 535 IPAs needed for initial Open
Enrollment decreasing to 134 until next Open
Enrollment
Continuous, real-time feedback from the FFE will becritical in continuously assessing our successes and
initiating needed improvements.
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Key Dates and Benchmarks
In-Person Assisters
IPA IT vendor selection
IPA Program and Processes Defined by December2012
IPA RFP Complete by January 2013 IPA RFP Advertised by February 2013
IPA Awards by May 2013
IPA Training by June 2013 Certified IPAs in the Field July 2013
Open Enrollment October 2013
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Plan Management Activities
Select EHB Benchmark Plan
Define QHP Certification Criteria and Processes
Decrease financial start up risks for issuers
- Risk Adjustment
- Reinsurance (temporary) - Risk Corridor (temporary)
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Plan Management Processes
Leverage Existing Processes within AID wherethey exist:
Life and Health
Rate Review Consumer Services
Finance
License Legal
Use Enhanced SERFF System
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EHB Benchmark Considerations
Compliance with ACA
Consumer Protection
Arkansas Health Needs
Overall Premium Costs and Value
State Mandated Benefits
Wellness Benefits Other
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EHB Benchmark
Rule 103 Directive 2-2012
Arkansas Blue Cross Blue Shield Health Advantage
(POS) with following Substitutions:
QualChoice Federal Plan Mental Health and Substance
Abuse Treatment Services ARKids First (CHIP) Pediatric Dental
Blue Cross Blue Shield Federal Plan (Blue Vision High) for
Pediatric Vision
Habilitative Services will likely be determined by
carriers with State oversight
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Selected Arkansas QHP Certification Criteria
Meet ACA Standards for Benefits and Actuarial Value
Increase Competition in Marketplace Arkansas Specifics:
Will use a certification approach for plan selection.
Will not require network adequacy or quality standards that
exceed federal ACA requirements in year one.
The Steering Committee acknowledges the emerging
importance of Arkansass Payment Improvement Initiative in
advancing quality and affordability and the Exchange may
engage or require carriers to adopt specific qualityimprovement strategies as a condition of having their QHPs
certified to be marketed and sold on the Exchange.
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Selected Arkansas QHP Certification Criteria
Will not require carriers to offer their QHPs statewide as a
condition of Exchange certification in year one, butrecommends consideration of a regional approach with
the goal of statewide coverage.*
Arkansas may limit the number of plans or benefit designsthat may be offered by a carrier on the exchange.*
Pass on options related to incentivizing carriers.
* Steering Committee recommended changes from PMAC recommendation.
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Expected Rules
Network Adequacy
QHP Certification
In Person Assister Certification
More
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Medicaid-Exchange Integration
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Continuous Coverage Across
Insurance Affordability Programs
How to mitigate negative effects of churning or
family members in different plans
Plan to study options using data that evaluates
costs and quality by benefit design, consumerdemand, and provider capacity, to include:
Current FFS
QHP Option Medicaid Plan Option
Bridge Plan
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Summary of Exchange Planning to Date
Planning GrantBackground Research;
Administrative Supplement to do Carrier Survey and
more Quality Definitions
Level One AContractors and Staff to begin serious
Plan Management and Consumer AssistancePlanning
Level One BPrepare for October 1, 2013 Open
Enrollment and Full Implementation of Partnership
Model by January 1, 2014; Study options to mitigate
negative effects of IAP churning and promote
continuity of coverage.
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Key Milestones Planning ReviewMay, 2012
On Track; Big Take Away was that Partnership States would
not issue Navigator Grants
Long-term financial sustainability model for FFE-P unknown
Design ReviewOctober 1-2, 2012
CCIIO/CMS staff very helpful; Arkansas waived out of mostBlueprint items for Partnership Model
Federal officials willing to negotiate implementation issues
with state; Long-term financial issues for FFE-P not
completely resolved, but state must be paid for service
Blueprint Application and Declaration Letter
November 16, 2012
Think about long- term plans
Collaborate with other states
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Key Milestones
QHP and Navigator Certification and Operational
Processes Design Complete by end of 2012
DHHS Conditional Approval as Partnership FFE byJanuary 1, 2013
Implementation ReviewSummer 2013
Open Enrollment October 1, 2013 and Partnership
Exchange is Fully Operational Covering Consumers byJanuary 1, 2014
The Future??
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Advance Planning for Hiring and Procurement
Carefully Plan Stakeholder Engagement Model;
Attract Diverse and Strong Leaders
Integrate Contractors into Planning and
Project Management
Utilize CCIIO Staff and Other Resources
Integrate with Other Health Improvement
Initiatives Be Persistent in Relationship Building
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Keep on message:
Arkansas will not have a State Exchange
FFE Partnership provides Arkansas:
Ability to meet ACA deadlines for compliancewith law
Opportunity to tailor Plan Management and
Consumer Assistance components to meet
needs of Arkansans Local design and implementation of Consumer
Services and Protections
Funding for connecting with FFE
Building Consensus
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Partnership with Medicaid Agency is critical
Consider and document majority and minority
opinions
Make decisions Move on
Keep consumer focus
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Summary
Arkansas has a tremendous need for coverage expansion. Cost, quality, and access improvements in Arkansass
healthcare system will benefit all Arkansans.
The Partnership Exchange allows Arkansas Insurance
Department to continue regulatory and consumer protectionfunctions for our residents.
Intentional efforts to mitigate negative effects of churning and
promote continuous coverage will be especially important
with our population. Transparency and inclusivity in planning is critical.
Keep consumer focus a priority.
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Questions/Comments
5016833634
www.hbe.arkansas.gov
mailto:[email protected]://www.hbe.arkansas.gov/http://www.hbe.arkansas.gov/mailto:[email protected]:[email protected]:[email protected]:[email protected]