Plan Management Stakeholder Committee May 5, 2016

Transcription

1 Plan Management Stakeholder Committee May 5, 2016

2 Welcome and Introductions

3 Standing Agenda Meeting Minutes Approval Feedback From the Field

4 Provider Directory Improvement Strategy Chapter 4, Section G, (vi): Provider Directory Improvement Strategy and Transparency Requirements Requirement: Issuers will assess the accuracy of their provider directories Methodology: - Issuers may use an assessment method of their own choosing - The assessment should attempt to determine whether the provider information currently in the issuer s directory is accurate Definition: An accurate depiction of the provider s current status as a provider in the issuer s network and, if the provider remains in network, the provider s current name, address, phone number, facility affiliations (if included), specialty, and acceptance of new patients. Submission Requirements: - Include in their assessment a review of any steps the issuer has taken to address the accuracy of the provider directory, such as outreach to providers and established methods for providers to update the issuer of changes in their directory information.

5 Provider Directory Improvement Strategy Chapter 4, Section G, (vi): Provider Directory Improvement Strategy and Transparency Requirements Submission Requirements: - Include timelines for when the efforts took place - Include the assessment output, i.e. percent accuracy of provider directory - Each issuer network listed within the provider directory must receive an assessment Format: - Narrative statement - PDF Submission Date and Manner: - Submit this assessment by August 1, Submit via the issuer s SERFF Binder - One submission per licensed entity

6 Dental Member Level Reports Issuer MLRs are important information tools used by MHBE - Allows MHBE to provide supplemental member support when consumers call in - Verification tool in the Escalated Cases Workflow to prevent Adverse Selection Issuers that do not submit timely MLRs impact member experience MHBE introduced reporting and frequency standards in the 2017 Final Letter to Issuers MLR standards will be included in draft regulation in June

7 Enrollments - QHP

8 Enrollments - MA

9 Quantitative, Provider Accessibility, Member Services Template Released in the Final Letter to Issuers: - C. Carrier Certification Standards, Requirement for Network Access Plan (v) Used to inform MHBE of an issuer s internal network adequacy standards Supplements an issuer s Network Access Plan Increases standardization across issuer responses, currently in narrative format Should be submitted in SERFF Binders as a part of the Carrier Application on July 1, 2016

10 Producer of Record

11 Producer Engagement

12 MHBE and Producers The Maryland Health Benefit Exchange (MHBE) provides its authorized insurance producers with enrollment assistance, plan advocacy and support services. Producers have enrolled over 37,000 lives in health coverage for 2016 coverage. This is an increase of over 10,000 enrollments from the total enrollments of 2015 (26,174) MHBE believes focusing on utilizing the existing ranks of highly skilled Authorized Producers will benefit not only the consumers but the Exchange, TPAs and carriers.

13 MHBE and Producers The Maryland Health Benefit Exchange work with over 1,100 producers which is a significant contribution to our consumer assistance workforce. Their expertise is invaluable to aid the public in choosing quality health plans that suits their specific needs. Carriers and TPAs have access to these producer advocates as well to enroll consumers, explain plans and resolve enrollment issues for consumers. It is our goal to better utilize these available resources for all parties. To improve and promote our continued partnership with insurance producers, MHBE Producer Operations is gathering information from our carrier and TPA partners.

14 Producer Contracting and Authorization

15 Producer Contracting with Carriers Carrier Contracting Carrier Input Requested MHBE is seeking to help educate producers on proper contracting requirements with carriers as an authorized Maryland Health Connection producer. MHBE requests that each carrier sends their contracting requirements for Exchange to

16 Producer Authorization Process Discussion Points Authorization Confirmation Currently, MHBE sends a list of authorized producers each week to our carrier contacts. Feedback is requested from carriers about how MHBE can help aid the contracting process.

17 Producer Authorization Process Common Reasons for Suspension of Authorization MHBE Producer Operations suspends producers for the following reasons. These suspensions can be a short period until the producer provides the requested information or they can last a good period of time or become permanent: Maryland Insurance License Expired Errors & Omissions Insurance Expired or Proof not Provided to MHBE Training Requirements Not Met Requested Documentation Not Provided (ex Privacy Statement)

18 Producer Authorization Process Authorization as it relates to Commissions Feedback is requested on how carriers currently determine if a producer should be paid commission for a policy. A couple of example situations are listed below: Authorized when policy sold but not at time of inquiry Suspension for a brief period while policy is active Policy not active when inquiry is made but was active for a short period of time.

19 Commission Payment Inquiries

20 Commission Inquiries Producers Inquiries made at MHBE regarding Commissions MHBE Producer Operations currently directs producers to their TPA to inquire about commission issues but there are follow-up situations when MHBE has to get involved: Producers are told that they are not connected as the producer at the carrier and/or Producer has contracting issues (i.e. not an authorized producer)

21 Errors with Producer Attachment Common Errors with Producer Attachment on an Enrollment File Producer and/or consumer did Tango process in system but did not confirm that the Producer assisted them with their application when completed. Other Consumer Assistance Worker helped a consumer make a change but neglected to confirm the Producer was still assisting the consumer Producer neglecting to complete the Tango Process Manual Enrollments not containing producer s information

22 Not Connected as Producer at Carrier Producer Not Connected at Carrier to Client When we get an inquiry, Producer Operations researches each enrollment to see: If the Producer s name and NPN went to the carrier on the enrollment files If the policy is active If a Producer of Record letter needs to be provided

23 Manual Producer of Record Process MHBE Process to Update Producer of Records Producer Operations completes research If an update needs to be completed, Producer Operations adds enrollment and producer information to a Producer of Record Update list that is sent to the carrier each week to ask for an update of the Producer of Record. Producer Operations has issued a memorandum to describe the manual Producer of Record process.

24 Producer of Record Letters Producer of Record Letters Process MHBE Producer Operations will request Producer of Record letters in two situations as listed below. Once received, we will add them to the Producer of Record Update List. No record in MHC System of attachment as the producer. Changes to Producer of Record

25 Partnership with the Carriers Carrier Communications with MHBE MHBE requests that carriers respond to confirm receipt of the Producer of Record Update within 5 days of receipt. And the Carrier either Confirms processing of Producer of Record Updates within 10 days of receipt, or Adds the Producer of Record information to their MLR report

26 Action Items

27 Contracting Due by 5/19/16 Provision of Contracting Process Information to be published to Producers Contracting Contact Names, s and Phone Number for publication to Producers. Due by 8/1/2016 Authorization Status/ Description of Carrier s Process for Contracting and Commission Payments Additional requirements for MHBE to facilitate the contracting process.

28 Commissions Due by 5/19/16 Response to Manual Producer of Record Process Confirmation of Receipt of Producer of Record Update List when received each week Confirmation of Carrier s Decision to either disclose processing status of Producer of Record updates and/or to provide this status update by adding the Producer of Record on the carrier s MLR report. Due by 8/1/2016 Information on how commission payments are affected by contracting or authorized status Advising if a Producer of Record Update cannot be processed due to contracting issues.

29 2017 Carrier Application The 2017 Carrier Application has been made available on marylandhbe.com/news-and-resources/toolbox/carriers-shopadministration/ Due June 1, 2016 to

30 Release 13: Renewals Dental and Health Changes

31 Schedule for Release 13: Renewals Dental and Health Changes Tentative Renewals Development/Testing Timeline 2016 April May June July Week Ending 4/3 4/10 4/17 4/24 5/1 5/8 5/1 5 5/2 2 5/2 9 6/5 6/12 6/19 6/26 7/3 7/1 0 7/1 7 7/2 4 7/3 1 Requirements System Design System Development System Testing User Acceptance Testing Carrier Testing Scenario Finalization Production Readiness Implementation 29

32 2017 QHP and SADP Renewals Tentative Renewal Timeline Technical Development 8/31 Rate Release 9/12 Final SERFF Submission 9/25 Final Certification Plan Certification Open Enrollment Period May June July Aug Sept Oct Nov Dec Jan 9/26 FD Batch Launch 10/15 FD Batch End 10/01 Plan Exit Notice 10/31 Deadline QHP Notice Report Changes

33 2017 QHP and SADP Renewals Tentative Stakeholder Sessions 05/05 (PMSC) Renewal Timelines, Carrier Renewal Notice, Issuers leaving the Marketplace 05/19 Follow-up Technical Session 06/02 (PMSC) Final Determination Notice Finalized, Messaging Campaign, & Plan Shopping Changes 06/09 Follow-up Technical Session with testing timeline 06/23 Final Technical Session

34 2017 QHP and SADP Renewals Carrier Notice The existing projected eligibility notice will be replaced by a single Final Eligibility Determination and Open Enrollment notice. - Notice still under development - Possible inclusion of additional special outreach groups in the notice

35 2017 QHP and SADP Renewals Issuers leaving the Marketplace Maryland Health Connection will not crosswalk members enrolled in the QHPs offered by issuers leaving the Marketplace into to other QHPs. These members will be required to return to Maryland Health Connection to enroll in a new QHP for a January 1, 2017 effective date. These members will receive additional special notification from MHC, in addition to the issuer plan exit notice, of this circumstance.

36 SHOP Update

37 Action Item Review

38 Action Item Review February 11, 2016, issuers needed to have provided MHBE with an extract of Exchange group Book of Business with Brokers and Subscribers. (Note: this is an outstanding item for some issuers) April, 2016: Issuers must submit the quarterly APTC reconciliation to MHBE (Note: this is an outstanding item for some issuers) May 2, 2016: Issuers must inform MHBE of the storage size for all of the required RI/RA reports, for SFTP configuration. (Note: this is an outstanding item for some issuers) July 1, 2016, Issuers should submit the completed survey by the initial QHP Application deadline. TBD Final Issuer Renewal Notices & Plan Exit Notices to MHBE upon finalization

39 Next Meeting Location

40 Questions or Comments?