MHBE currently there is no code for aging terminations but will be coming out

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1 EIAC Meeting Welcome Kevin Yang and Michele Eberle opened the meeting. The members present and on the phone introduced themselves. Michele Eberle thanked the group members for their effort and participation in the open enrollment. Administrative Items Two sets of minutes for approval 03/20 issue of individuals who will potentially fail the financial viability test. And MHBE did not yet receive the information on CMS. Follow up, CMS will provide guidance of the following week. Correct meeting minutes to include 4/4 Lena Hershkovitz discussed the correction with the EIAC schedule whereby the first Thursday of the month is in person and the third Thursday is via conference. Lena requested an with confirmation of committee representatives by Friday. Individual Exchange Topics Aging out of dependents, ramifications on maintenance of correct premium and APTC. Kevin Yang provided scenarios of how MHBE would approach aging out for comment by the EIAC members. For the presented information please see the posted slide deck. CareFirst is there a code for aging out of dependents? MHBE currently there is no code for aging terminations but will be coming out there is however a termination code we send over that can be filled in by the carrier CareFirst we should discuss aging out in general with regard to 65 - Medicare Dave Brock can we bring up this conversation with the SHOP MHBE we will address that through the SHOP discussion at the end of the meeting MHBE would perform all SEP outreach and notification to both the household leader and the aging out dependent that they will receive an eligibility redetermination, i.e. APTC and CSR. Two SEPs would exist in this situation, for the original household and the household of the individual aging out. MHBE the effective date for the new enrollment would be no sooner than the 1 st of the month after the event If there is a grace period what are the individual s rights for the SEP? Particularly if the grace is 90 days, extending past the SEP notice. MHBE will double check. CareFirst should we know that a person is in grace when we receive an SEP code for aging out? MHBE what if family terminates before overaging and what about whether the person is in grace MHBE will develop scenarios to answer these questions.

2 Concern is what if the consumer remains passive? What if the consumer will take no action to the notices? MHBE will do the adjustment if consumer remains passive. Consumers would receive three notices, two from their carrier (notice of change and premium adjustment) and one from MHBE (redetermination). There was discussion about a possible gap in coverage original household should the consumers take the full SEP. There is a timing issue with regarding to consumer response and the APTC/CSR change. MHBE will discuss the policy implications and return with information. Mary Lou are the carriers are reaching out the individual who is being aged out? CareFirst everybody receives notices MHBE will check to see if the individual who is being aged out will be contacted with their notices. Does MHBE have enough information to contact the aging out person? Kaiser we currently inform only the subscriber Mary Lou how does the individual know that he has a 120 special enrollment period? Sandy will you also be notifying that the individual must also be a Maryland resident to enroll in these plans? MHBE will check back. What are current processes for carriers for those aging out? MHBE there may be a month with premium mismatch. There are numerous implications including tax liabilities that may arise. MHBE would like to know what carriers are currently doing with regard to aging out. There may also be APTC mismatches that MHBE will have to determine policy on how to handle. CareFirst carriers can autocorrect invoices to make the difference in case of several months with APTC mismatch MHBE will officially ask if carriers can backdate an adjustment on their 834 file. MHBE has several follow-up questions to ask and will agglomerate the comments. MHBE will share the drafted notices.

3 5/1 Plan Maryland is allowing citizens who did not complete enrollment by April 1 st to have until April 18 th to do so. MHBE has begun an aggressive outreach campaign. Ratio of Medicaid vs. QHP - 80:20 or so. Three or four thousand are expect to select QHPs. MHBE is taking ample metrics and will look into sharing this data with committee members. Consumers must sign an attestation to participate. MHBE will consult with decision makers to discuss how members will be impacted by the decision Plan Certification Guidelines for 2015 Lena discussed the proposed certification standards, the changes made in the final letter, and the recommendations provided by the committee carriers. MHBE will send out these Plan Certification standards to the committee members. Dental out-of-pocket maximum changes? MHBE will post these changes for formal comment shortly. MHBE would like make this decision quickly given the filing deadline. SHOP Direct Enrollment Lena discussed changes to SHOP Direct enrollment procedures for minimum participation standards. There are two one month periods with no minimum participation standards. Mary Lou will there be a SHOP for the fall? MHBE that is the intent. MHBE would like to tell brokers what the carriers are doing so that they are aware when they are assisting their clients. MHBE will request formal statements with acknowledgement of the minimum participation standards and their business practices for the year. UnitedHealthCare discussed the implications to carriers of the minimum participation rules indicating that the SHOP was supposed to be a level playing field across carriers and now that it is a Direct Enrollment Process the level is removed. Carriers can set their participation rules up to 75% Coventry can we tell brokers that the 5/15 to the 6/15 window is open for direct enrollment? MHBE yes these dates are set in stone, there has been guidance issued that carriers must receive their applications in this window MHBE can only dictate for on Exchange products. Standing Advisory Committee The committee has been selected and is posted on the MHBE website.

4 Board Decision Secretary FitzGerald made the recommendation to the Exchange board to adopt the system created by Connecticut. Maryland would take the source code and would adapt the code to fit Maryland s needs. Connecticut s model is very compatible with Maryland s technological infrastructure as well. Deloitte has been negotiated with to be the system integrator to develop the system that will be live for the next open enrollment. CMS has been kept in the loop the whole way. There is a tightened timeline between now and November 1 st. Deloitte will undertake a gap analysis to ascertain what functions and technologies will be supported by the Connecticut system. Carriers will be actively contacted for plan data exchanges and any changes to EDI. Mary Lou will the EIAC be the same for this implementation? MHBE still being developed. But the Standing Committee will be involved for consumer issues. MHBE is only taking the individual Connecticut solution. SHOP decisions will require addition internal discussions. Carriers requested Connecticut system requirements for integration to be shared with the committee. Mary Lou why is there no data available for analysis from the current system MHBE since we have such a short timeframe we may not do a complete data transfer between the old and new systems MHBE will not do a full member migration. CareFirst we need to know our requirements by mid-may in order meet our release dates CareFirst we need to know what is coming from old system and going into the new system. MHBE we will leverage the new system as much as possible. Including for the redeterminations. MHBE will formally ask carriers about the lead times required to develop their own systems. MHBE has asked carriers to submit burning questions. CareFirst how much is going to customized? how much will we keep the same? CareFirst would like documentation. Kaiser would like to know how this change pertains to SHOP.

5 Members Present Kevin Yang Michele Eberle Tanya Robinson Josh Curtis Louisa Tavakoli William Armstrong UnitedHealthCare Mary Lou Fox Sandy FirstName LastName Shawn Brashears KAIG Shanell Gray HCentive Kristine Wade Kaiser Permanenter David Mosier Benefit Mall Liz Moriarty Delta Douglas Beuc Coventry Sukhi Singh Kaiser Permanenter Wilma Lopez Aetna Jenn DuBois Dentaquest Tim Fischer Connecture Sara Martineson Coventry Giri Govada MHBE Stacy Dum United Concordia Marci Ochoa Conexis Tanya Robinson Kaiser Permanente Julie Pare Conventry Steve Bahleda Aetna Angela Townsend Kaiser Permanente Patrick Breen CareFirst Beth Ziegler Aetna Amy Derivan United Concordia Stephanie Walters Coventry Kathy Simmons GBSIO Lynn Foster UnitedHealthCare Dean Rogers Dominion Varun Sheoran Kaiser Permanente

6 Mary Cavey Connecture Lori Heverly GLIC Bemnet Abebe Aetna Pat Yoshitsu Delta David Brock Coventry Lee Diemer Benefit Mall evan beck Healthplan Services Suzanne Dorsch Coventry Kelly Calvillo Conexis Erick Verry Aetna Amita Bhanvadia CareFirst KC Bobrowski Delta Paula Gates Coventry Anne Yau UnitedHealthGroup Dave Abeshouse GBSIO