Arkansas Health Insurance Marketplace
|
|
- Diane Carter
- 5 years ago
- Views:
Transcription
1 Independent Accountant s Report on Applying Agreed-Upon Procedures June 30, 2018
2 Independent Accountant s Report on Applying Agreed-Upon Procedures Little Rock, Arkansas We have performed the procedures enumerated in this report, which were agreed to by Arkansas Health Insurance Marketplace (Exchange), related to the processes and internal controls over the compliance with specified financial and programmatic requirements of the Centers for Medicare & Medicaid Services (CMS) of the Marketplace for the year ended June 30, 2018, solely to assist the Exchange in meeting the financial and programmatic requirements as specified by CMS for completion of certain aspects of the Exchange s 2018 State-based Marketplace Annual Reporting Tool (SMART) submission. The management of is responsible for its compliance with these requirements. The sufficiency of these procedures is solely the responsibility of the parties specified in this report. Consequently, we make no representation regarding the sufficiency of the procedures described in this report either for the purpose for which this report has been requested or for any other purpose. Because the Exchange utilizes the federal platform, our scope was limited to the sections of 45 Code of Federal Regulations (CFR) part 155 applicable to the structure of the Exchange. The findings obtained are described below. Subpart C General Functions of an Exchange 45 CFR part Functions of an Exchange We discussed the federal requirements in 45 CFR 155 with the Exchange s chief financial officer in order to gain an understanding of the Exchange s operations and the applicability of the requirements. We viewed a Memorandum of Understanding (MOU) in place between the Exchange and Arkansas Insurance Department (AID) that provides details on the responsibilities of the two entities. 45 CFR part Consumer assistance tools and programs of an Exchange We discussed the federal requirements of 45 CFR with the process owners of key roles to determine that they have adequate understanding of the related requirements and that the Exchange-required information was available to consumers.
3 Page 2 We viewed the MyARInsurance website maintained by the Exchange and observed that the following information is displayed: the toll-free hotline number. We observed the personnel working the toll-free hotline line and reviewed call center scripts that convey how consumers are directed to the appropriate support entities for enrollment. 45 CFR part Ability of States to permit agents and brokers to assist qualified individuals, qualified employers, or qualified employees enroll in QHPs (Qualified Health Plans) We discussed the federal requirement in 45 CFR with the process owners of key roles and determined that they pose adequate overall knowledge of the related requirements. We obtained and read training materials over privacy, security and compliance to determine that the Exchange has training materials available to train and register agents or brokers assisting in enrolling others in QHPs. Subpart K Exchange Functions: Certification of Qualified Health Plans 45 CFR part Certification standards for QHPs We discussed the federal requirements with process owners of key roles and documented their understanding of the certification standards and responsibilities for ensuring compliance. We obtained and read the MOU in place between the Exchange and AID that provides details on the responsibilities of the two entities. We obtained and read the Act to determine that it provides for the implementation of procedures and criteria for the certification of health benefit plans. We noted that the notice of benefit and payment parameters, the AID bulletin and the letter to issuers were all available online.
4 Page 3 45 CFR part Certification process for QHPs have an understanding of the certification process and responsibilities for ensuring compliance. We viewed the Health Insurance Rate Review (HIRR) and the AID websites for certified QHPs. We viewed the timeline outlined by AID to become certified and the checklist created to assist issuers in the submission of a QHP. 45 CFR part QHP issuer rate and benefit information have an understanding of the process for handling and updating rate and benefit information. We selected one rate increase processed for BlueCross BlueShield (BCBS) in May 2018 posted on the website and viewed documentation that evidences review and approval by AID of the requested increase. We obtained and read the Rating Filing Summary and Summary of Benefits and Coverage to determine that they included rates, covered benefits, and cost-sharing requirements (co-pays or co-insurance). 45 CFR part QHP certification standards related to advance payments of the premium tax credit and cost-sharing reductions have an understanding of the processes in place to achieve compliance with the related requirements. We viewed the System for Electronic Rate and Form Filing (SERFF) website for exchange of rate allocation information between AID and CMS/Health and Human Services (HHS) to determine that an exchange process is in place to administer advance payments of the premium tax credit and cost-sharing reductions.
5 Page 4 45 CFR part Transparency in coverage We inquired of the process owners of key roles and document AID s process for collecting information from QHP issuers. We read the Arkansas version of the Individual Form Review QHP Checklist and noted the checklist covered the following specific items related to the regulations: plan enrollment, rates, coverage of benefits, cost-sharing information, premiums, reporting and transparency requirements. We viewed a Rate Filing Summary and Summary of Benefits and Coverage for one QHP on the Health Insurance Rate Review (HIRR) website and noted that the QHP issuer has made costsharing information available. 45 CFR part Establishment of Exchange network adequacy standards have an understanding of the review process in place to ensure that QHP network adequacy standards are met. We viewed the Arkansas version of the Individual Form Review QHP Checklist and noted that the Exchange has a process in place to monitor whether the provider network of each QHP meets the standards specified in Section CFR part Service area of QHP We discussed the federal requirements with process owners of key roles and documented AID s processes for evaluating service area adequacy. We obtained and read the Arkansas version of the Individual Form Review QHP Checklist and noted that it addresses service areas.
6 Page 5 45 CFR part Stand-alone dental plans We inquired of the process owners of key roles and documented the dental plans offered through the Exchange. We compared the plan designs to the general requirements in Section (a) and noted dental plans offered through the Exchange were allowable under the federal regulations. Using the Anonymous Shopping tool, we viewed the Summary of Benefits and Coverage for QHPs on the Exchange website and noted dental plans offered were consistent with our documentation of stand-alone dental plans offered through the Exchange. 45 CFR part Recertification of QHPs We inquired of the process owners of key roles and documented the recertification process. We obtained and read the Arkansas version of the Individual Form Review QHP Checklist used for the certification/recertification process and noted that the Exchange has established a process for recertification of QHPs. For one recertification selected haphazardly, we viewed a QHP recertification processed in May 2018 on the HIRR website. We viewed the Excel-based plan certification template available to carriers on the SERFF website and noted that the Exchange has established a process for recertification of QHPs. We observed the recertification selected above was approved and processed prior to the September 15 deadline. 45 CFR part Decertification of QHPs We inquired of the process owners of key roles and documented the decertification and appeals process and required notices. We inquired with a representative of AID who represented that there were no decertifications of QHPs by AID during 2018.
7 Page 6 This agreed-upon procedures engagement was conducted in accordance with attestation standards established by the American Institute of Certified Public Accountants and the standards for attestation engagements contained in Government Auditing Standards, issued by the Comptroller General of the United States. We were not engaged to and did not conduct an examination or a review, the objective of which would be the expression of an opinion or conclusion, respectively, on compliance with the specified requirements. Accordingly, we do not express such an opinion or conclusion. Had we performed additional procedures, other matters might have come to our attention that would have been reported to you. The purpose of this report is solely to assist the Exchange in meeting the financial and programmatic requirements as specified by CMS for completion of certain aspects of the Exchange s 2018 SMART submission. Accordingly, this communication is not suitable for any other purpose. Little Rock, Arkansas January 15, 2019
Plan Management Blueprint Overview
Plan Management Blueprint Overview Arkansas Plan Management Committee September 7, 2012 www.pcghealth.com Agenda Blueprint Overview Look at Plan Management Sections Review of Draft Responses Associated
More informationFrom: Center for Consumer Information and Insurance Oversight (CCIIO) Title: DRAFT 2016 Letter to Issuers in the Federally-facilitated Marketplaces
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Center for Consumer Information & Insurance Oversight 200 Independence Avenue SW Washington, DC 20201 Date: December 19, 2014
More informationMaryland Health Benefit Exchange dba Maryland Health Connection
Maryland Health Benefit Exchange dba Maryland Health Connection Application for Participation in the Individual and Small Business Health Options Program (SHOP) Marketplace General Information The Plan
More informationArkansas Health Insurance Marketplace Key Decisions Inventory. April 9, 2014
I. Introduction and Methodology Introduction Over the next six weeks, Public Consulting Group (PCG) will assemble an inventory of key decisions that the Board and the Executive Director may use to establish
More information1 DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 200 Independence Avenue SW Washington, DC 20201 Date: May 1, 2013 From: Center for Consumer Information and Insurance Oversight
More informationPlan Management Stakeholder Committee May 5, 2016
Plan Management Stakeholder Committee May 5, 2016 Welcome and Introductions Standing Agenda Meeting Minutes Approval Feedback From the Field Provider Directory Improvement Strategy Chapter 4, Section G,
More informationState Consultation on the Development of a Federal Exchange
State Consultation on the Development of a Federal Exchange The Affordable Care Act (ACA) directs the Secretary of Health and Human Services (HHS) to facilitate the establishment of an Exchange in any
More informationBlueprint for Approval of Affordable Statebased and State Partnership Insurance Exchanges
Blueprint of Afdable based and Partnership Insurance Exchanges Introduction The Afdable Care Act establishes Afdable Insurance Exchanges (Exchanges) to provide individuals and small business employees
More informationAdvisory Memorandum. March 6, Plan Year Form, Rate, and Plan Binder Filing Information
Advisory Memorandum TO: FROM: RE: All Insurers of Health Benefit Plans 1 in the Individual and Small Group Markets and/or of Exchange-Certified Stand-alone Dental Plans Life and Health Division 2016 Plan
More informationQHP Issuer Workshop Part II
QHP Issuer Workshop Part II QHP Application and Review Process Overview, Part II April 15, 2014 www.pcghealth.com Schedule and Logistics Meeting Information The meeting will be available in Webex. To join
More informationDate: March 14, Does the February 27 th bulletin apply to all Marketplaces or only State-based Marketplaces?
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Center for Consumer Information & Insurance Oversight 200 Independence Avenue SW Washington, DC 20201 Date: March 14, 2014
More informationDraft Blueprint for Approval of Affordable State-based and State Partnership Insurance Exchanges
Draft Blueprint of Afdable -based and Partnership Insurance Exchanges Introduction The Afdable Care Act establishes Afdable Insurance Exchanges (Exchanges) to provide individuals and small business employees
More informationMy Arkansas Insurance
My Arkansas Insurance More Competitive More Options g More Arkansas Welcome Arkansas Health Insurance Marketplace 2016 Board Retreat Wednesday September 21 st, 2016 1 Agenda 1. Welcome and Chairman s Remarks
More informationCarrier Training: Carrier Authorization and Plan Certification. A service of Maryland Health Benefit Exchange
Carrier Training: Carrier Authorization and Plan Certification A service of Maryland Health Benefit Exchange Agenda Welcome and Introductions Overview of Carrier Authorization and Plan Certification Carrier
More informationAdvisory Memorandum March 29, All Insurers of Exchange Certified Stand-alone Dental Plans
Advisory Memorandum TO: FROM: All Insurers of Exchange Certified Stand-alone Dental Plans Life and Health Division The purpose of this memorandum is to notify all interested insurers of important filing
More informationGeneral Guidance on Federally-facilitated Exchanges
1 General Guidance on Federally-facilitated Exchanges Center for Consumer Information and Insurance Oversight Centers for Medicare & Medicaid Services May 16, 2012 2 Contents I. Background... 3 II. State
More informationThe Center for Consumer Information & Insurance Oversight Rate Public Use File Data Dictionary
CMS Center for Consumer Information & Insurance Oversight (CCIIO), Health Insurance Marketplace Public Use Files (PUF) Data Dictionary for Rate PUF 1. Overview of the Rate PUF The Centers for Medicare
More informationINDEPENDENT EXTERNAL AUDIT: 2016 AUDIT FINDINGS REPORT
INDEPENDENT EXTERNAL AUDIT: 2016 AUDIT FINDINGS REPORT RHODE ISLAND RHODE ISLAND HEALTH INSURANCE EXCHANGE DBA HSRI (HEALTHSOURCE RHODE ISLAND) Rhode Island State Based Marketplace 2016 Audit Findings
More informationa service of the Maryland Health Benefit Exchange Third-Party Administrator Reference Manual
a service of the Maryland Health Benefit Exchange Third-Party Administrator Reference Manual Release 1.0 July 2013 Table of Contents Section 1: General Information 1 Manual Purpose...4 2 Maryland Health
More informationAffordable Insurance Exchanges
Affordable Insurance Exchanges DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS for MEDICARE & MEDICAID SERVICES Center for Consumer Information and Insurance Oversight December 7, 2011 The material in
More informationOverview of October 24, 2013 Final Rule on Program Integrity: Exchange, Premium Stabilization Programs, and Market Standards
Overview of October 24, 2013 Final Rule on Program Integrity: Exchange, Premium Stabilization Programs, and Market Standards November 1, 2013 Overview of October 24, 2013 Final Rule on Program Integrity:
More informationPlans; Exchange Standards for Employers, 77 Fed. Reg (March 27, 2012) (to be codified at 45 C.F.R. pts. 155, 156, and 157).
May l8, 2012 Establishment of Exchanges and Qualified Health Plans and Exchange Standards for Employers The New England Council James T. Brett President & CEO Healthcare Committee Chairs Frank McDougall
More informationAgenda. 1. Federal Health Care Reform: Background and Overview. 2. Exchange Operations. 3. Exchange Establishment Funding
Agenda 1. Federal Health Care Reform: Background and Overview 2. Exchange Operations 3. Exchange Establishment Funding Federal Health Care Reform: Background and Overview Affordable Care Act PPACA, Affordable
More informationCCIIO Marketplace Matrix
Contract offers to Indian health care providers (IHCPs) make contract offers to all available ICHPs to meet the ECP standard. If not meeting this standard, a QHP issuer must provide an explanation of the
More informationAffordable Insurance Exchanges: More Choices, Competition and Clout
Affordable Insurance Exchanges: More Choices, Competition and Clout An Exchange is a State-based competitive marketplace where individuals and small businesses will be able to purchase affordable private
More informationGUIDANCE FOR PARTICIPATION IN THE WASHINGTON HEALTH BENEFIT EXCHANGE
GUIDANCE FOR PARTICIPATION IN THE WASHINGTON HEALTH BENEFIT EXCHANGE March 2016 Washington Health Benefit Exchange 810 Jefferson Street SE Olympia, Washington 98501 Table of Contents Table of Contents
More informationIssue Brief: Non-EHB Benefits in Qualified Health Plans and Private Option
Issue Brief: Non-EHB Benefits in Qualified Health Plans and Private Option Issue Overview Qualified Health Plans (QHPs) are required to cover the ten Essential Health Benefits (EHBs) mandated in the Affordable
More informationState Decisions: Federally Facilitated Exchange (FFE) States
State Decisions: Federally Facilitated Exchange (FFE) States Data coordination Will state confirm insurer licensure, solvency, and good standing? In order to certify a plan as a QHP, an FFE must verify
More information2018 Minnesota Health Insurance MNsure Plan Certification Guidance for Qualified Dental Plans
2018 Minnesota Health Insurance MNsure Plan Certification Guidance for Qualified Dental Plans Table of Contents Introduction... 2 What s New for Plan Year 2018... 2 Certification Requirements for QDPs
More informationConnecticut Health Insurance Exchange Health Plan Benefits and Qualifications Advisory Committee (HPBQ AC) Special Meeting
Connecticut Health Insurance Exchange Health Plan Benefits and Qualifications Advisory Committee (HPBQ AC) Special Meeting Holiday Inn, Salon A East Hartford Wednesday, January 10, 2018 Meeting Minutes
More informationCENTERS FOR MEDICARE AND MEDICAID SERVICES SPECIAL TERMS AND CONDITIONS. Arkansas Health Care Independence Program (Private Option)
CENTERS FOR MEDICARE AND MEDICAID SERVICES SPECIAL TERMS AND CONDITIONS NUMBER: TITLE: 11-W-00287/6 (Private Option) AWARDEE: Arkansas Department of Human Services I. PREFACE The following are the amended
More informationState Plan Management Systems and Submission Deadlines for 2015
Plan Management Systems and Submission Deadlines for 2015 Questions related to HIOS may be directed to the HIOS Help Desk at 1-877-343-6507 or insuranceoversight@hhs.gov. Questions related to SERFF may
More informationSubject HHS Commentary From Preamble Regulatory Provision Agent Specific Provisions Definition of Agent/Broker
National Association of Health Underwriters Overview of Provisions in the Proposed Federal Rule on the Establishment of Exchanges and Qualified Health Plans (Released on July 11, 2011) of Specific Interest
More informationArkansas Health Insurance Marketplace
Arkansas Health Insurance Marketplace Request for Information RFI ID: 2014-01 Implementation Services for the Arkansas Health Insurance Exchange Individual Marketplace Information Technology Solution TABLE
More informationArkansas Health Care Independence Program Presentation to Arkansas Plan Management Advisory Committee. May 10, 2013
It Arkansas Health Care Independence Program Presentation to Arkansas Plan Management Advisory Committee May 10, 2013 Pertinent Arkansas Events to Date February 22, 2013 Sebelius Meeting March 13, 2013
More informationAon Retiree Health Exchange What your retirees need to know
Aon Retiree Health Exchange What your retirees need to know Q. Why is OP&F changing our current health care coverage? A. Funding for the retiree health care plan at OP&F is limited, making the group health
More informationHealth Insurance Exchange Blueprint Application Progress. Public Meeting Presentation October 10, 2012
Health Insurance Exchange Blueprint Application Progress Public Meeting Presentation October 10, 2012 What is the Blueprint? The Blueprint is the application describing readiness to perform Exchange activities
More informationSmall Business Health Options Program (SHOP) Policy Recommendations
Small Business Health Options Program (SHOP) Policy Recommendations February 12, 2013 A service of Maryland Health Benefit Exchange Rating and Defined Contribution in the Employer Choice Model Proposed
More informationActuarial equivalence will be confirmed via an actuary s letter from the health insurance issuer to the State
Essential Health Benefits Draft proposed rules on November 20, 2012 outlining the EHBs that qualified health plans must cover Based on section 1302 of the Affordable Care Act 10 EHB categories (emergency,
More informationFrom: Center for Consumer Information and Insurance Oversight (CCIIO)
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Center for Consumer Information and Insurance Oversight 200 Independence Avenue SW Washington, DC 20201 Date: January 15,
More information1. Overview of the Benefits and Cost Sharing PUF
CMS Center for Consumer Information & Insurance Oversight (CCIIO), Health Insurance Marketplace Public Use Files (Marketplace PUF) Data Dictionary for Benefits and Cost Sharing PUF 1. Overview of the Benefits
More informationTo: Issuers Seeking to Participate in Maryland Health Connection in 2020
Date: December 7, 2018 From: The Maryland Health Benefit Exchange To: Issuers Seeking to Participate in Maryland Health Connection in 2020 Title: DRAFT 2020 Letter to Issuers Seeking to Participate in
More informationWashington Health Benefit Exchange
Washington Health Benefit Exchange QHP/QDP Certification Board Meeting August 21, 2013 Beth Walter Operations Director Susanne Towill Senior Plan Manager QHP/QDP Certification Process 8/21/13 -- 4/1/13
More information2019 Plan Certification Standards. MHBE Staff Recommendations
2019 Plan Certification Standards MHBE Staff Recommendations Network Adequacy 2018 Plan Certification Standard Proposed 2019 Plan Certification Standard Network Access Plans & Network Adequacy: Carriers
More information6 Direct enrollment process for Marketplace sales. Individual major medical plans for individuals and families
6 Direct enrollment process for Marketplace sales Individual major medical plans for individuals and families Direct enrollment with Assurant Health You ll know what s going on every step of the way Controlled
More informationCOVERED CALIFORNIA QUALIFIED HEALTH PLAN ISSUER CONTRACT FOR FOR COVERED CALIFORNIA FOR SMALL BUSINESS. between
COVERED CALIFORNIA QUALIFIED HEALTH PLAN ISSUER CONTRACT FOR 2017 2019 FOR COVERED CALIFORNIA FOR SMALL BUSINESS between Covered California, the California Health Benefit Exchange (the Exchange ) and (
More informationArkansas Health Care Independence Program. State Legislative Quarterly Report
Arkansas Health Care Independence Program State Legislative Quarterly Report April 1, 2015 to June 30, 2015 I. Program Enrollment Enrollment in the Arkansas Health Care Independence Program continued to
More informationSupporting Statement: Risk Corridors Data Validation for the 2014 Benefit Year
Supporting Statement: Risk Corridors Data Validation for the 2014 Benefit Year A. Justification 1. Circumstances Making the Collection of Information Necessary Under Section 1342 of the Patient Protection
More informationHealth Insurance Exchanges: Health Insurance Navigators and In-Person Assistance
Cornell University ILR School DigitalCommons@ILR Federal Publications Key Workplace Documents 9-25-2013 Health Insurance Exchanges: Health Insurance Navigators and In-Person Assistance Suzanne M. Kirchhoff
More informationAdopted by the NAIC Health Insurance and Managed Care (B) Committee on June 27, 2012 Intended for Use by the States as Guidance Only
Introduction Adopted by the NAIC Health Insurance and Managed Care (B) Committee on June 27, 2012 NAIC Form Review White Paper Under the federal Patient Protection and Affordable Care Act (ACA) 1, an American
More informationOHIC 2016 Form Filing Instructions Individual and Small Group
OHIC 2016 Form Filing Instructions Individual and Small Group A. General Instructions 1. The following are Form Filing Instructions for the State of Rhode Island Office of the Health Insurance Commissioner
More informationFrequently Asked Questions on Exchanges, Market Reforms and Medicaid
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop C2-21-15 Baltimore, Maryland 21244-1850 Date: December 10, 2012 Subject: Frequently Asked
More informationState Considerations for Health Insurance Exchanges. Krista Drobac, Director, Health Division September 21, 2012 American Osteopathic Association
State Considerations for Health Insurance Exchanges Krista Drobac, Director, Health Division September 21, 2012 American Osteopathic Association Consumer Consumer Relationships Public Payors Qualified
More informationHealth Insurance Marketplace All Blue 2014 Workshops
1 All Blue 2014 Workshops Agenda 2014 Marketplace Performance Financial Assistance Impact on Uninsured Individual Market Demographics Membership by Service Area Membership by Previous Coverage Membership
More informationArkansas Health Care Independence Program. State Legislative Quarterly Report
Arkansas Health Care Independence Program State Legislative Quarterly Report April 1, 2014 to June 30, 2014 I. Program Enrollment Enrollment in the Arkansas Health Care Independence Program continued to
More informationUpdate on the New York Health Benefit Exchange Sherry Tomasky Director, Stakeholder Engagement
Update on the New York Health Benefit Exchange Sherry Tomasky Director, Stakeholder Engagement Westchester-Putnam Access to Health Care Coalition April 18, 2013 What is an Exchange? Organized marketplace
More informationBoard of Directors Meeting
Access Health CT Board of Directors Meeting January 18, 2018 A. Call to Order and Introductions B. Public Comment C. Votes Review and Approval of Minutes Appoint Theodore Doolittle to the Health Plan Benefits
More informationPreparing for the Health Insurance Exchanges
Preparing for the Health Insurance Exchanges HFMA Forums Virtual Networking Event February 23, 2012 2:00 3:00 pm Central Time Agenda Overview of the health insurance exchanges Key lessons from the Massachusett
More informationPlan Management Stakeholder Committee July 19, 2018
Plan Management Stakeholder Committee July 19, 2018 Standing Agenda Welcome and Introductions Meeting Minutes Approval PMSC 2018 Schedule March 1-Renewals Debrief and Direction and 1095-A Results May 3-PayNow
More informationNavigator, Agent and Broker Work Group
Minnesota Health Insurance Exchange Navigator, Agent and Broker Work Group Advisory Task Force Meeting October 24, 2012 Advisory Task Force Meeting Navigator, Agent & Broker Work Group October, 2012 Summary
More informationAdopted Permanent Rules Relating to Policies and Procedures to Certify Entities to Deliver Consumer Assistance Services
1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 1.23 1.24 1.25 Adopted Permanent Rules Relating to Policies and Procedures to Certify Entities to Deliver
More informationStand-Alone Dental Plan Issuer Marketing Guidelines. (DRAFT - October 21, 2013)
Stand-Alone Dental Plan Issuer Marketing Guidelines () Overview and Purpose C o v e r e d C a l i f o r n i a S A D P I s s u e r M a r k e t i n g G u i d e l i n e s The Covered California Marketing
More informationCHAPTER 11: HEALTHSOURCE RI SHOP ELIGIBILITY
CHAPTER 11: HEALTHSOURCE RI SHOP ELIGIBILITY TABLE OF CONTENTS A. Overview of HealthSource RI SHOP... 1 B. SHOP Employer Eligibility & Enrollment Procedures... 1 1) SHOP Employer Eligibility Requirements...
More informationHEALTHSOURCE RI STATEMENT OF REVENUES AND EXPENDITURES. Year Ended June 30, With Independent Auditor's Report
HEALTHSOURCE RI STATEMENT OF REVENUES AND EXPENDITURES With Independent Auditor's Report INDEPENDENT AUDITOR'S REPORT Management of the Rhode Island Health Benefits Exchange d/b/a HealthSource RI Report
More informationCost-Sharing Reductions (CSRs): Advance Payments for April 16, Payment Policy and Financial Management Group 1
Cost-Sharing Reductions (CSRs): Advance Payments for 2015 April 16, 2014 Payment Policy and Financial Management Group 1 Agenda Guidelines Purpose Intended Audience Overview The New CSR Advance Payment
More informationThis chapter sets forth the structure, implementation, and eligibility standards for the State
Title 14 Independent Agencies Subtitle 35 Individual Exchange Chapter 17 State Reinsurance Program Authority: Insurance Article, 31-117(f), Annotated Code of Maryland.01 Scope. This chapter sets forth
More informationMinnesota Health Insurance Exchange Plan Certification Guidance. October 9, 2012
Minnesota Health Insurance Exchange Plan Certification Guidance October 9, 2012 The purpose of this guidance is to describe the certification requirements intended to apply to Qualified Health Plans (QHPs)
More informationPatient Protection and Affordable Care Act; Exchange Functions: Standards for
DEPARTMENT OF HEALTH AND HUMAN SERVICES 45 CFR Part 155 [CMS-9955-P] RIN 0938-AR75 Patient Protection and Affordable Care Act; Exchange Functions: Standards for Navigators and Non-Navigator Assistance
More informationHHS Releases Notice of Benefit and Payment Parameters for 2019 Proposed Rule
If you have questions, please contact your regular Groom attorney or one of the attorneys listed below: Jon W. Breyfogle jbreyfogle@groom.com (202) 861-6641 Lisa M. Campbell lcampbell@groom.com (202) 861-6612
More informationDEPARTMENT OF HEALTH AND HUMAN SERVICES. Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment
DEPARTMENT OF HEALTH AND HUMAN SERVICES 45 CFR Parts 153, 155, 156, 157 and 158 [CMS-9964-F] RIN 0938-AR51 Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2014
More informationIndependent External Audit Report: Programmatic Audit Findings Report Plan Year Ended December 31, 2016
Independent External Audit Report: Plan Year Ended December 31, 2016 State of Maryland Table of Contents BACKGROUND... 3 PURPOSE AND AUTHORITY... 4 OBJECTIVES AND SCOPE... 4 GENERALLY ACCEPTED GOVERNMENT
More informationOverview of Health Insurance Exchanges
Namrata K. Uberoi, Coordinator Analyst in Health Care Financing Annie L. Mach Analyst in Health Care Financing Bernadette Fernandez Specialist in Health Care Financing July 1, 2016 Congressional Research
More informationRHODE ISLAND GOVERNMENT REGISTER PUBLIC NOTICE OF PROPOSED RULEMAKING
AGENCY: Department of Administration (DOA) DIVISION: HealthSource RI (HSRI) RULE IDENTIFIER: R23-1-1-ACA, ERLID No. 8400 RHODE ISLAND GOVERNMENT REGISTER PUBLIC NOTICE OF PROPOSED RULEMAKING REGULATION
More informationHealth Plan Benefits & Qualifications (HPBQ) Advisory Committee
1 Access Health CT Health Plan Benefits & Qualifications (HPBQ) Advisory Committee January 10, 2018 Today s Agenda 2 A. Call to Order and Introductions B. Public Comment C. Vote: December 13, 2017 Meeting
More informationCompliance and Fraud, Waste, and Abuse Awareness Training. First Tier, Downstream, and Related Entities
Compliance and Fraud, Waste, and Abuse Awareness Training First Tier, Downstream, and Related Entities 1 Course Outline Overview Purpose of training Effective Compliance program Definition of Fraud, Waste,
More informationRequest for Information Health Insurance Exchange Platform and Customer Service Center
Request for Information Health Insurance Exchange Platform and Customer Service Center This solicitation is a Request for Information (RFI) only. It is NOT a solicitation for quotations, bids, or proposals.
More informationState Plan Management Systems and Submission Deadlines for Plan Year 2017
Plan Management Systems and Deadlines for Plan Year 2017 Questions related to HIOS may be directed to the HIOS Help Desk at 1-877-343-6507 or insuranceoversight@hhs.gov. Questions related to may be directed
More informationCalifornia Code of Regulations Add Article 9. Plan-Based Enrollers ( 6700 et seq.) Title 1. Investment Chapter 12. California Health Benefit Exchange
California Code of Regulations Add Article 9. Plan-Based Enrollers ( 6700 et seq.) Title 1. Investment Chapter 12. California Health Benefit Exchange 6700 Definitions... 2 6702 Certified Plan-Based Enrollment
More informationCAREFIRST BLUECROSS BLUESHIELD PART III ACTUARIAL MEMORANDUM
CAREFIRST BLUECROSS BLUESHIELD PART III ACTUARIAL MEMORANDUM 1. REDACTED ACTUARIAL MEMORANDUM (AM): CareFirst (CF) is making no redactions so both AM submissions are the same. 2. GENERAL INFORMATION: A.
More informationReporting Requirements FAQs
Reporting Requirements - 6055 Frequently Asked Questions Reporting Requirements - 6055 FAQs Summary On March 10, 2014, the U.S. Department of the Treasury and IRS published final rules to implement the
More informationAnalysis of Affordable Care Act (ACA) Market Stabilization Final Rule 1. April 19, 2017
Analysis of Affordable Care Act (ACA) Market Stabilization Final Rule 1 April 19, 2017 This brief seeks to provide guidance to Tribes on a final rule issued on April 18, 2017, by the federal Centers for
More informationNational Provider Identifier Frequently Asked Questions. SECTION I What do I need to know about NPI?
National Provider Identifier Frequently Asked Questions SECTION I What do I need to know about NPI? 1. What is the National Provider Identifier (NPI)? The NPI is a unique identification number for health
More informationQuestions from Agents/Producers
Questions from Agents/Producers Q. How will income be determined? Will we take the word of the consumer about their income without verifying? A. Incomes will be verified by the data hub on the Federal
More informationState Health Reform Assistance Network Charting the Road to Coverage
Charting the Road to Coverage ISSUE BRIEF August 2011 HHS Proposed Rules on Exchange Implementation Requirements Prepared by Manatt Health Solutions -- Deborah Bachrach, Patricia Boozang, Melinda Dutton
More informationRe: Comments on Draft 2017 Letter to Issuers in the Federally-facilitated Marketplaces
January 17, 2016 The Honorable Sylvia Mathews Burwell Secretary of Health and Human Services 200 Independence Avenue SW Washington, D.C. 20201 Re: Comments on Draft 2017 Letter to Issuers in the Federally-facilitated
More informationIllinois State Partnership Exchange Blueprint Application
Illinois State Partnership Exchange Blueprint Application 3.14 - Pre-Existing Conditions Insurance Plan (PCIP) Transition Plan The Exchange will follow procedures established in accordance with 45 CFR
More informationIn addition to the definitions in Section 6410 of Article 2 of this chapter, for purposes of this article, the following terms shall mean:
CERTIFIED PLAN-BASED ENROLLMENT PROGRAM OF THE CALIFORNIA HEALTH BENEFIT EXCHANGE CALIFORNIA CODE OF REGULATIONS, TITLE 10, CHAPTER 12, ARTICLE 9 ADOPT SECTIONS 6700, 6702, 6704, 6706, 6708, 6710, 6712,
More informationPlan Year 2019 QHP Certification
Plan Year 2019 QHP Certification Nevada SBM-FP Notes (Nevada is considered a State Based Marketplace Federal Platform) QHP Submission through SERFF QHP Approval/Certification for on exchange plans by the
More informationESSENTIAL COMMUNITY PROVIDER PETITION FOR 2017 BENEFIT YEAR FREQUENTLY ASKED QUESTIONS
/Dean M. Seyler/ ESSENTIAL COMMUNITY PROVIDER PETITION FOR 2017 BENEFIT YEAR FREQUENTLY ASKED QUESTIONS Q1. Under what authority is HHS collecting this provider data? A1. In accordance with section 1311(c)(1)(C)
More informationSTATE OF WASHINGTON. Re: Patient Protection and Affordable Care Act; Exchange Program Integrity [CMS P]
STATE OF WASHINGTON The Honorable Seema Verma Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Attention: CMS-9922-P 7500 Security Boulevard Baltimore, MD
More informationHHS Issues Proposed Rules on Implementing Health Insurance Exchanges
HHS Issues Proposed Rules on Implementing Health Insurance Exchanges July 2011 The Department of Health and Human Services (HHS) on July 11, 2011 released two sets of proposed regulations to implement
More informationDate: February 6, From: Center for Consumer Information and Insurance Oversight, Centers for Medicare & Medicaid Services
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Date: February 6, 2014 From: Center for Consumer Information and Insurance Oversight, Centers for Medicare & Medicaid Services
More informationThank you for considering BlueCross BlueShield of Western New York for your Medicare Advantage needs.
Dear Neighbor: Thank you for considering BlueCross BlueShield of Western New York for your Medicare Advantage needs. Why you re receiving this letter Enclosed are the Centers for Medicare and Medicaid
More informationMaryland Health Connection An Update on Maryland s Implementation of the State-Based Exchange
Maryland Health Connection An Update on Maryland s Implementation of the State-Based Exchange Tequila Terry Director, Plan & Partner Management Maryland Health Benefit Exchange October 4, 2013 Today s
More informationNovember 27, RE: CMS 9930 P, Notice of Benefit and Payment Parameters for Dear Administrator Verma,
OFFICERS & DIRECTORS Chair THERESA McCONEGHEY Principal Financial Group Des Moines, IA November 27, 2017 Seema Verma, Administrator Centers for Medicare and Medicaid Services 200 Independence Ave., SW
More informationPatient Protection and Affordable Care Act: HHS Notice of Benefit and Payment Parameters for 2014 Final Rule Summary.
Patient Protection and Affordable Care Act: HHS Notice of Benefit and Payment Parameters for 2014 Final Rule Summary March 21, 2013 On March 11, 2013, the Centers for Medicare & Medicaid Services (CMS)
More informationACA Impact on State Regulatory Authority: Health Plans Outside Exchanges
ACA Impact on State Regulatory Authority: Health Plans Outside Exchanges Section 1321(d) of the Patient Protection and Affordable Care Act (ACA) specifically states that nothing in this title shall be
More informationCovered California 3/5/2019. Title 10. Investment. Chapter 12. California Health Benefit Exchange. Article 11. Certified Application Counselor Program
Title 10. Investment Chapter 12. California Health Benefit Exchange Article 11. Certified Application Counselor Program 6850. Definitions. (a) For purposes of this Article, the following terms shall have
More informationMAXIMUS Webinar Series
MAXIMUS Webinar Series The New Beneficiary Support System Requirements and Other Beneficiary Protections Continuing the Discussion on the CMS Rule for Medicaid & CHIP Managed Care June 8, 2016 1 Introductions
More informationFinal 2018 Notice of Benefit and Payment Parameters
HIGHLIGHTS The ACA s out-of-pocket maximum limit increases to $7,350 (self-only coverage) and $14,700 (family coverage). The required contribution percentage for the individual mandate s affordability
More information