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Health Insurance Exchange
Workgroup
August 29, 2012
Presented by:
Tom Donovan, Deputy Director, Insurance
Valerie Fend-Boehm, Project Staff
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Agenda
1. Subcommittee Support
2. CCIIO Blueprint Review
3. CCIIO Guidance Review
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Subcommittee Support
Introduction
Support
Research & resource support
Attend sub-committee meetings
Assist with other needs/requests
Weekly Resource List
Evolving Tool
For you!
8/29/2012Health Insurance Exchange Work Group 3
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Overview of Blueprint for
Approval of Affordable State-
based and State Partnership
Insurance Exchanges
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Blueprint Review
What?
Identifies options for State flexibility in the
development of Exchanges.
Outlines specific requirements to apply forapproval as a State Based Exchange or
Federally-facilitated Partnership Exchange.
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Blueprint Review
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Flexible Exchange Options for States
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Blueprint Review
Exchange Approval Timeline for Plan Year
2014
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Blueprint Review
Transition Timeline
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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
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Blueprint Review
Blueprint Approval
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Full Approval Conditional Approval
Meet all approval
requirements on January 1,2013
Do not meet all requirements,
but are making significantprogress
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
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Blueprint Review
Declaration Letter:
Part I of Application
Required for SBE, FFE-P, and FFE (with
reinsurance) States; encouraged for FFE.
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Blueprint Review
Assumptions in the Absence of an Declaration Letter The State will not administer it own reinsurance program;
The States small group and individual markets will bemerged in the Federally-facilitated exchange only if thecurrent 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 qualifiedemployee to enroll only in QHPs in the small-groupmarket; and
The States 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 sizewill be based on full-time equivalent employees consistentwith other Affordable Care Act policies.
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Blueprint Review
Application
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Blueprint Review
Exchange Blueprint submission includes:
Attestations of completion of Exchange
Activities or the dates of expected completion
Supporting documentation, includingdescriptions 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
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Blueprint Review
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Blueprint Review
More Information?
CCIIO Blueprint Deep-Dive Webinars
Questions?
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Overview of General Guidance
on Federally-facilitatedExchanges
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Guidance Review
What?
Outlines HHSs approach to implementing an
FFE in a state without a SBE, including:
How States can partner with HHS to implementselected 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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Guidance Review
Section I: Background
Section II: State Partnership in an FFE
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Guidance Review
Section III: Approach to Key ExchangeFunctions 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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Guidance Review
Section IV: Stakeholder Input HHS will work closely with local stakeholders
to implement each FFE, including in State
where a Partnership is operating. HHS iscommitted to creating a transparent process
for FFE development in each State, and will
seek input from stakeholders and provide
technical assistance to those stakeholdersworking with an FFE.
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Guidance Review
Questions
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Thank you
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