New York State Health Benefit Exchange: Implementation Update

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1 New York State Health Benefit Exchange Health Benefit Exchange: Implementation Update Danielle Holahan Deputy Director New York Health Benefit Exchange Health Care for All New York January 17,

2 Executive Order 42 Establishing New York Health Benefit Exchange Establishes New York Benefit Exchange within the Department of Health Directs the DOH, in conjunction with the Department of Financial Services and other state agencies, to take all steps necessary to effectuate the Exchange Requires the Exchange to: Facilitate enrollment in health coverage and the purchase and sale of qualified health plans Enable eligible individuals and small businesses to receive federal tax credits Convene regional advisory committees to provide advice and make recommendations Become financially self sustaining by January 1, 2015 as required by the ACA 2

3 Regional Advisory Committees Approximately 200 individuals participate on one of 5 regional committees, providing advice in the planning and implementation of the Exchange Includes consumers, small businesses, health care providers, insurers, brokers, labor and others Five regions NYC Metro Long Island Capital/Mid Hudson/North Central New York Western 3

4 New York Health Benefit Exchange System Development Contract with Computer Sciences Corporation Development tracks: Eligibility and Enrollment Plan Management Customer Service SHOP Financial Reporting 4

5 Federal Grant Support to Plan and Implement New York s Exchange Planning Grant Awarded to NYS Insurance Department to begin the planning process ($1M) Early Innovator Grant NY selected as one of 7 states to build information systems to operate the Health Insurance Exchange ($27.4M) Establishment Level One (June 2011) Awarded to the NYS Department of Health to continue the planning process and conduct policy studies ($10.7M) Establishment Level One (Dec 2011) Awarded to the NYS Department of Health to continue the planning process, support Exchange IT, consumer assistance activities, and conduct policy studies ($48.5M) Establishment Level One (June 2012) Awarded to the NYS Department of Health to continue the planning process, support Exchange IT, staff, Exchange operations, advertising, outreach, and marketing, consumer assistance activities ($95.5M) Establishment Level Two (Nov 2012) Awarded to the NYS Department of Health for remaining establishment and year one operational activities, including Exchange IT, Call Center, advertising, outreach and marketing, In Person Assistors, and Exchange staff. ($186M) 5

6 Completed Exchange Policy Studies Study Simulation Modeling Market Merger & Group Size Basic Health Plan Benefit Standardization Reinsurance/Risk Adjustment Third Party Assisters Essential Health Benefits Consultant Urban Institute Urban Institute Urban Institute Wakely Consulting Wakely Consulting Wakely Consulting Milliman Available at: 6

7 Forthcoming Exchange Policy Studies Study Insurance Markets Medicaid Benchmark Benefits Continuation of State Health Programs: Consultant Health Management Associates Health Management Associates Deloitte Consulting Healthy New York and Family Health Plus Employer Buy In Health Savings Accounts Small Business Health Options Program (SHOP) Simulation Modeling: Coverage Impacts on a Sub State Level Health Disparities Deloitte Consulting KPMG Wakely Consulting Urban Institute The Center for Popular Democracy 7

8 HHS Process to Certify State Based Exchanges 8

9 The Blueprint for Federal Approval Demonstrate operational readiness to execute Exchange activities Exchange Declaration Letter submitted on July 9, 2012; updated letter on November 14, 2012 Blueprint Application: Attest to completion of Exchange activities or dates of expected completion Describe processes and strategies Attach reference files and summaries of results of test scenarios Application process aligns with establishment grant review process Submitted October 26, 2012

10 The Thirteen Blueprint Areas 1. Legal Authority and Governance 2. Consumer and Stakeholder Engagement and Support 3. Eligibility and Enrollment 4. Plan Management 5. Risk Adjustment and Reinsurance 6. Small Business Health Options Program (SHOP) 7. Organization and Human Resources 8. Finance and Accounting 9. Technology 10. Privacy and security 11. Oversight, Monitoring and Reporting 12. Contracting, Outsourcing and Agreements 13. State Partnership Activities 10

11 New York Health Benefit Exchange Implementation Timeline: High Level HHS Blueprint Submitted: Oct 26, application Blueprint updates posted to Exchange website HHS Conditional Certification: Dec 14, 2012 Qualified Health Plan and Navigator/In Person Assistor Invitations Released: late January 2013 Exchange begins accepting applications on Oct 1, 2013 Individual and SHOP Exchange coverage effective Jan 1,

12 Additional Information Questions regarding implementation can be sent to: 12

Update 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