Delaware Health Benefit Exchange (HBE) Project Update

Delaware Health Care Commission Meeting: December 6, 2012

Topics • Updates on key targets, progress to-date, and upcoming activities

• Exchange Project Overview

• Level One Grant Submission

• Declaration Letter

• Blueprint Application submission

• EHB Rule Update

• Consumer Assistance 2.0

• Marketplace Assistance Program

• Marketplace Assister Certification Standards

• Public Comment Process and Deadlines

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Delaware Exchange Project

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DE Exchange Timeline of Key Targets*

*Target dates identified for 2013 represent estimates based on current guidance

Level One Grant Submission

• November 15, 2012 - Submitted second Level One grant to continue funding of Exchange implementation for the next 12 months

• Activities funded under this grant include:• Continued development of consumer assistance program based on changes to

partnership model• Support for operation of plan management functions specific to the Exchange (QHP

certification processing, verification needs, ongoing monitoring)• Communications and outreach funding • Marketplace Assister grant funding

• If awarded, new funding will be available January 2013

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Declaration Letter

• Each State must submit a declaration letter to HHS identifying the Exchange model they intend to pursue

• Gov. Markell submitted Delaware’s declaration letter to HHS on November 15, 2012

• Delaware was the second state to formally declare intention to enter into a State Partnership for Plan Management and Consumer Assistance

• In addition to identifying the State Partnership model chosen, the letter also notified HHS of the State’s intention to leverage federal administration of the reinsurance program and retain final determination of Medicaid eligibility

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Blueprint Application Submission

• Regulations implementing the Affordable Care Act require HHS to approve or conditionally approve State-based Exchanges no later than January 1, 2013, for operation in 2014.

• For State partnerships, the State must demonstrate its readiness to perform plan management, consumer assistance, and eligibility functions related to coordination of Medicaid eligibility by submitting several artifacts to HHS.

• Delaware was waived out of requirements for plan management based on documentation the State submitted in Oct 2012 during its Design Gate Review.

• The remaining required documents will be submitted to HHS in early December 2012

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EHB Proposed Rule Update

• Habilitative Services• DE adopted the standard included in previous guidance of requiring habilitative

services to be offered at parity with rehabilitative services included in the EHB benchmark

• The new rule offers additional options to states for defining these services, including the option to define the set of services outside of any benchmark

• Pediatric Vision• DE adopted the standard from previous guidance requiring that the EHB

benchmark will be supplemented by the Federal Employees Dental and Vision Insurance Program (FEDVIP) benefit standard.

• The new rule offers the option for states to supplement this benefit using the applicable CHIP benefit standard.

• In an effort to keep premiums low and minimize additional impacts on the commercial market for 2014 and 2015, the State has opted to uphold the original supplement decisions for each of the categories. These options, along with all other EHB choices, will be reanalyzed for 2016.

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Consumer Assistance 2.0

Original Guidance Current Guidance

State will manage, train, and oversee Navigator program as defined by the ACA

State will oversee Navigator program, but Federal Government will select, fund, and certify individuals. Navigators will not be selected until late summer of 2013.

State will conduct any other in-person consumer assistance activities

State will be required to create a Marketplace Assistance program that is separate and distinct from the Navigator program.

Federal government will manage call center and website

State is currently working with Center for Consumer Information and Insurance Oversight (CCIIO) to understand the transfer protocols and processes for managing call center and web consumer interactions.

No mention of broader outreach and education efforts

Office of Communications was planning outreach campaign for partnership states. Now the Office will defer to States as requested. 8

Navigators

• Navigators are trusted members of the communities they serve who will engage and assist consumers in seeking health coverage on the Exchange.

• Delaware understands that the Federal Government will be responsible for awarding grants to Navigators for the State of Delaware, certifying Navigators, and providing several federal training modules to support this program.

• Navigators will provide a more specialized level of assistance closer to the start of open enrollment, focusing particular attention on underserved and hard to reach populations within the State.

• They will also provide information in a manner that is culturally and linguistically appropriate to meet the needs of the population being served by the Exchange

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Marketplace Assistance (MPA) Program

The State has determined that the MPAs will play a central and far reaching role in supporting consumer assistance for the Exchange.

• MPAs will be expected to possess: o A strong knowledge of public and private coverage options available in the State, o Connections to the communities that the Exchange will serve, and o The time and resources to provide case management services for consumers with

questions and concerns that require communication and follow up with other State entities.

• The MPAs, having been selected and trained by the State on Exchange operations and functions early in 2013, will be the main outreach arm into the communities they currently serve, acting as the first point of contact for the majority of consumers.

• The State will perform ongoing monitoring and evaluation of the MPAs

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Marketplace Assister Certification StandardsThe State of Delaware recommends application of the following criteria to all individuals

who seek official recognition and compensation as an MPA for the State of Delaware:

• Applicants will need to meet the following requirements:• Complete State specific training program• Provide 3 letters of reference from members of the community the applicant

serves.• Provide written attestations to the following requirements:

• Applicant is not employed by a health insurance issuer; subsidiary of a health insurance issuer, or an association that includes members of or lobbies on behalf of the insurance industry or health insurance issuer.

• Applicant does not possess any other conflict of interest that would prohibit the objective exercise of the individual’s official or professional responsibilities.

• Applicant agrees to comply with professionally accepted ethical standards in the course of carrying out the individual’s official and professional responsibilities.

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Marketplace Assister Certification Standards (Cont).

• Applicant does not receive direct or indirect payments from any health insurance issuer in connection with enrollment of qualified individuals or qualified employees in a Qualified Health Plan (QHP) as explicitly prohibited by Federal law.

• Applicant does not receive compensation of any kind from any other entity for enrolling individuals in health plans, and agrees to disclose any past compensation earned and received from plans during the previous 24 months, reason for compensation, and whether the applicant intends to receive future compensation from any plan or insurer in the health care community.

• Applicant commits to participating in on-going training following initial certification.• Applicant agrees to a criminal background check in accordance with State and

Federal rules. Please note that the appearance of past offenses in a background check will not automatically exclude the applicant from consideration. Applicants will be evaluated on a case by case basis.

• Applicant agrees to put consumer safety first in carrying out the duties of the MPA• Applicant is lawfully present.• Applicant is at least 18 years of age. • Applicant can demonstrate basic computer and internet skills or indicate a

willingness to learn.

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Public Comment Process and Deadlines

• Similar to the QHP standards process, we are seeking public comments regarding these proposed MPA certification standards.

• Draft standards, including description of proposed criminal background check process and professionally accepted ethical standards will be available for download on the HCC website.

• Please submit comments to the HBE email account: HBE_Delaware@state.de.us or directly to the Health Care Commission by December 22, 2012.

• Final standards will be presented for Commission review at the January 3, 2013 meeting.

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