workgroup presentation 082912

8/13/2019 Workgroup Presentation 082912

1/23

Health Insurance Exchange

Workgroup

August 29, 2012

Presented by:

Tom Donovan, Deputy Director, Insurance

Valerie Fend-Boehm, Project Staff

18/29/2012Health Insurance Exchange Work Group


2/23

Agenda

1. Subcommittee Support

2. CCIIO Blueprint Review

3. CCIIO Guidance Review

28/29/2012Health Insurance Exchange Work Group


3/23

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


4/23

Overview of Blueprint for

Approval of Affordable State-

based and State Partnership

Insurance Exchanges



5/23

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.



6/23

Blueprint Review


Flexible Exchange Options for States


7/23

Blueprint Review

Exchange Approval Timeline for Plan Year

2014



8/23

Blueprint Review

Transition Timeline


Plan

Year

Blueprint Due Operational Coverage Begins

2014 November 16, 2012 October 01, 2013 January 01, 2014




9/23

Blueprint Review

Blueprint Approval


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


10/23

Blueprint Review

Declaration Letter:

Part I of Application

Required for SBE, FFE-P, and FFE (with

reinsurance) States; encouraged for FFE.



11/23

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.



12/23

Blueprint Review

Application



13/23

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



14/23


15/23

Blueprint Review



16/23

Blueprint Review

More Information?

CCIIO Blueprint Deep-Dive Webinars

Questions?



17/23

Overview of General Guidance

on Federally-facilitatedExchanges



18/23

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.



19/23

Guidance Review

Section I: Background

Section II: State Partnership in an FFE



20/23

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)



21/23

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.



22/23

Guidance Review

Questions



23/23

Thank you


workgroup presentation 082912

Documents