Affordable Insurance Exchanges

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presentation should not be viewed as having any independent legal effect, or relied upon as an

1 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 this presentation should not be viewed as having any independent legal effect, or relied upon as an interpretation or modification of the related proposed rule or statute. Not all issues or exceptions are fully addressed.

2 Affordable Care Act In March 2010, Congress passed and the President signed into law the Affordable Care Act, which puts in place comprehensive health insurance reforms that will hold insurance companies more accountable, lower health care costs, guarantee more health care choices, and enhance the quality of health care for all Americans. Many important benefits are already in place, including: Bans on the worst insurance company abuses Cost savings for seniors, families and small and large businesses Coverage options for many Americans who have been locked out of the insurance market because of a pre-existing condition. More information on the Affordable Care Act can be found at healthcare.gov. 2

3 Affordable Insurance Exchanges The Affordable Care Act creates Affordable Insurance Exchanges, competitive marketplaces providing affordable health plan options for individuals and small businesses (SHOPs) Exchanges will be operational in each State by January 1, 2014 HHS will run an Exchange on behalf of a State that does not elect to run an Exchange or receive approval to do so by January 1,

4 Affordable Insurance Exchanges Exchanges are designed for consumers and small businesses. They are State-based competitive marketplaces where individuals and small businesses can: Find information and compare qualified health plans Determine eligibility for tax credits for private insurance or health programs like the Children s Health Insurance Program (CHIP) Easily enroll in a qualified health insurance plan that meets their needs. The Affordable Care Act and the proposed rules build a number of important consumer protections into Exchanges. 4

5 Five Core Functions of the Exchange Consumer Assistance Consumer support assistors; education and outreach; Navigator management; call center operations; website management; and written correspondence with consumers to support eligibility and enrollment. Plan selection approach (e.g., active purchaser or any willing plan); collection Plan and analysis of plan rate and benefit package information; issuer monitoring Management and oversight; ongoing issuer account management; issuer outreach and training; and data collection and analysis for quality. Accept applications; conduct verifications of applicant information; determine Eligibility eligibility for enrollment in a Qualified Health Plan and for insurance affordability programs; connect Medicaid and CHIP-eligible applicants to Medicaid and CHIP; and conduct redeterminations and appeals. Enrollment Financial Management Enrollment of consumers into qualified health plans; transactions with Qualified Health Plans and transmission of information necessary to initiate advance payments of the premium tax credit and cost-sharing reductions. User fees; financial integrity; support of risk adjustment, reinsurance, and risk corridor programs. 5

6 State Flexibility States will have significant flexibility to create an Exchange that best fits their needs and is responsive to local market conditions. For example: Structure of the Exchange; Qualified Health Plan Selection; Network Adequacy Standards; Marketing Standards; Role of Agents and Brokers in Exchange. 6

7 Timeline e for States Ongoing: Technical assistance from HHS Ongoing: Establishment reviews of state progress Ongoing: Apply for Establishment Grant Funding (upcoming deadlines are Dec. 30, 2011, March 30, 2012, June 29, 2012) Spring 2012: Exchange Approval Application anticipated release Fall 2012: Start Accepting Exchange Approval Applications January 1, 2013: Final Exchange approval and conditional approval decisions made January 1, 2013 Fall 2013: Ongoing technical assistance and establishment reviews for conditionally approved Exchanges 7

8 HHS Activity/Progress ty/ Proposed Rules issued this Summer on Exchange Functions, Structure, Eligibility, SHOPs, Tax Credits, Qualified Health Plans Federal funding for States for planning and establishing Exchanges; Early Innovator Grants IT Guidance; grantee conferences; Technical Assistance Federal Procurements to build HHS Exchange (with Treasury & IRS) and Data Services HUB Questions and Answers to states 8

9 State Progress Background research Stakeholder consultation IT gap analysis a s Adoption of governance model Legislation to create an Exchange Exchange Establishment grants As of November 29, 2011, 28 States and DC have received Exchange Establishment grants from HHS 9

10 Goals of the Exchanges Expanded d Coverage: Exchanges will expand coverage in the individual id and small group markets by offering high-value health plans, lowering administrative costs, and increasing purchasing power. Promoting Competition: Exchanges will be competitive marketplaces with vastly improved transparency and direct comparisons based on benefits, price, and quality. Affordable Options: Health plans will be more affordable with financial assistance, including premium tax credits, cost-sharing reductions, and Small Business Tax Credits available for coverage purchased through the Exchange. Quality Improvement: Exchanges will drive quality and delivery system reform, while ensuring consumer protections. 10

State 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