Carrier Training: Carrier Authorization and Plan Certification. A service of Maryland Health Benefit Exchange

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1 Carrier Training: Carrier Authorization and Plan Certification A service of Maryland Health Benefit Exchange

2 Agenda Welcome and Introductions Overview of Carrier Authorization and Plan Certification Carrier Administration Portal (CAP) Demo Template review and Plan Quality import Plan Shopping Demo Testing process CRISP Integration Producer Topics Wrap-up 2

3 Purpose of Carrier Training To keep carriers informed about key deliverables related to carrier authorization and plan certification Discuss policy decisions that affect carrier operations Demonstrate how online tools are to be used by carriers, state administrators, and consumers 3

4 Authorized Carriers Maryland has adopted a strategy for that allows any willing carrier to offer qualified health plans on Maryland Health Connection as long as they meet federal and state requirements. This approach will foster competition in the marketplace and help to build stability for Maryland Health Connection. Medical Aetna CareFirst Coventry Evergreen (CO-OP) Kaiser United HealthCare Aetna Dental BEST Life CareFirst Coventry Delta Dental DentaQuest Dominion Dental Guardian Metropolitan Life United Concordia Stand-Alone Dental List reflects names of carriers by parent company name. 4

5 Plan Certification Workflow Step 1 Submit Participation Intent Form Step 2 Submit Contracts, Forms & Rates to MIA Step 3 Complete Carrier Application Package Step 4 Submit Approved Plans & Check Data to MHBE for Final Certification Step 5 Provider Network Data to CRISP Step 6 MHCC Plan Quality & Performance Data November 15, 2012 April 1, 2013 May 1, 2013 July-August, 2013 July 2013 August 2013 Statement of Intent to Participate SERFF Licensure Compliance with Federal Requirements Maryland Health Connection Carrier Administration Portal CRISP FTP Site Annual Custom File from MHCC Health Plan HEDIS Scores Preliminary Information on Service Area, Product Types, Accreditation Status Key Contacts for Planning & Implementatio n Solvency Benefits, Rates & Forms Essential Health Benefits Limitations on Cost Sharing Actuarial Value/Metal Levels Discriminatory Benefit Design Compliance with State Requirements Terms & Conditions for Participation List of Plans Required Templates Required Attestations Plan Shopping Data Network Providers Essential Community Providers Health Plan CAHPS Scores Health Plan Behavioral Health Assessment Scores Quality Profile RELICC Data

6 Tools for Carrier Authorization and Plan Certification Carrier Reference Manual version 2.0 Main policy document for Carriers Outlines Authorization and Certification process in detail Plan Certification Checklist Contains all of the elements that will need to be submitted and time frame in which submission will occur 6

7 Carrier Administration Portal In plan year one, all documents required for carrier authorization and plan certification will be submitted via the Carrier Administration Portal (CAP) in Maryland Health Connection MHBE will not be using SERFF or HIOS to send or receive plan management documents or data 7

8 Time Constraints Plans expected to be approved by the Maryland Insurance Administration between July 1 and July 31, 2013 Carrier Administration Portal (CAP) expected to be available to carriers by the end of July 2013 All plans must be certified by end of August 2013 so that data can go to CMS by August 31, 2013

9 Review of the Plan Certification Checklist

10 Carrier Administrator Portal (CAP) Process Flows

11 Carrier Registration and Application 11

12 State Reviews Carrier Application 12

13 Carrier Imports QHP Plans and Rates 13

14 Carrier Submits QHP Plans 14

15 State Reviews Plans 15

16 State Activates Plans 16

17 State Imports Quality 17

18 Carrier Modified Rates Mid-Plan Year 18

19 State Creates QHP Plans for Recertification 19

20 Carrier Recertifies Plans 20

21 State Unauthorizes Carrier 21

22 Carrier Appeal of Unauthorization 22

23 State Manages Carrier Appeal 23

24 State Decertifies Plan 24

25 Carrier Appeals Plan Decertification 25

26 State Manages Plan Appeal 26

27 State Administrator Portal Functions 27

28 Carrier Administrator Portal Functions 28

29 Carrier Testing Process - Update

30 Carrier Testing Process Updates Kick-Off Webinar held on May 22 with all carriers to kick-off testing process Carriers were asked to provide: Overall Testing Point of Contact Information IT Point of Contact Information (essential for connectivity testing) Source IP Address SFTP Public Key PGP Public Key MHBE has only received this information from 5 of the carriers approved to offer products through the Exchange Please provide POC information even if you re not ready to begin testing at this time Documentation All integration documentation is available at the following: 30

31 Carrier Testing Process Weekly Response Cycle Tuesday - Carriers send all questions to Kerry Connolly & carriertesting@engagepoint.com Questions received after Tuesday COB receive response in the following week s response cycle Wednesday Weekly Carrier Testing Meeting will review the list of questions and assign ownership. Tuesday by 12PM Noridian to provide question response to Kerry Tuesday COB Kerry Connolly provides response to Carriers. 31

32 Carrier Testing Process Additional Information Points of Contact Interface Testing Coordinator (scheduling testing, facilitation of status meetings), Kerry Connolly, (office), (mobile), Interface Technical Contact (requesting access to the test environment, report defects, coordinate testing, or any other matters): Hasina Rahman. Next Steps Once we have your POCs and connectivity information, we ll send you information on where and how to schedule a time to test. Thank you! 32

33 Producer Topics

34 Interim Procedures MHBE has adopted interim procedures to cover the essential steps needed for carriers to offer health plans on the Maryland Health Connection. Part 1 Policies and Interim Procedures Plan Certification Plan Recertification Plan Decertification Plan Submission Limits Part 2 Policies and Interim Procedures Dental & Vision Plan Offering and Price Display Producer Incentives Part 3 Policies and Interim Procedures Producer Appointments Please refer to the Carrier Reference Manual version 2.0 for copies of all adopted interim procedures.

35 Producer Appointments Producer Appointments Interim procedures provide rules for carriers when appointing producers: A carrier must appoint an authorized producer within 10 business days of receipt the request A carrier must appoint every authorized producer unless reasons specified under 31112(e)(1), Annotated Code of Maryland A carrier can not deny appointment based on production volume A carrier can not impose a production requirement A carrier must allow authorized producers to discuss all Maryland Health Connection plans with or without an appointment A carrier must provide a basis for denial to the authorized producer within 10 business days Dispute resolution will be managed by the MIA While the dispute is being reviewed by the MIA, the producer can continue to sell and enroll individuals and small businesses A carrier can limit the scope of an appointment to only Maryland Health Connection A carrier must provide information on their producer register upon request of the MHBE 35

36 Producer Compensation Carriers will continue to be responsible for compensation of producers that sell plans on Maryland Health Connection. Carriers will continue to develop their own models of compensation for producers. Compensation models must not result in the disruption of consumers access to qualified plans, steering of consumers away from appropriate insurance offerings, or threaten the viability of Maryland Health Connection. Carriers are expected to develop equivalent compensation and incentives for sales inside and outside of the state-based exchange. Carriers are required to collect and maintain producer compensation data including agreements, policies, procedures, programs and other information regarding producer compensation. Carriers must provide this information to the Maryland Insurance Administration upon request. Please refer to the Carrier Reference Manual version 2.0 to see the Exchange Board Statement of Policy on Producer Compensation.

37 Next Steps

38 Action Items / Next Steps Move forward with testing Respond promptly to MIA correspondence More information will be given regarding CAP Availability Final due dates for plan certification