Washington Health Benefit Exchange

Transcription

1 Washington Health Benefit Exchange QHP/QDP Certification Board Meeting August 21, 2013 Beth Walter Operations Director Susanne Towill Senior Plan Manager

2 QHP/QDP Certification Process 8/21/ /1/13 -- Issuer QHP Submission Form Due 4/1/13 -- OIC Regulatory Review Process and QHP Certification Process Begins 7/19/13 -- HBE Issuer Participation Agreement Due HBE Board Meeting to finalize QHP & QDP Certification 2

3 Plan Management QHP Timeline Event Due Date Letter of intent to participate in Healthplanfinder January 22, 2013 P HBE issues Final Guidance for Participation February 1, 2013 P HBE issues Final QHP Issuer Submission Checklist March 1, 2013 P HBE and OIC perform QHP certification and regulatory review processes April 1, 2013 July 31, 2013 P HBE issues Final HBE Participation Agreement June 10, 2013 P QHP issuers satisfy any remaining QHP certification criteria to HBE staff August 9, 2013 P HBE Board certifies QHPs for 2014 August 21, 2013 Board meeting P CCIIO Financial Data Submission for QHPs August 31, 2013 QHP issuers ratify QHP benefit and rate data in HBE Product Center system QHPs available for SHOP employers to select for initial effective date of January 1, 2014 QHPs available in Healthplanfinder for an initial effective date of January 1, 2014 September 10 & 11, 2013 October 1, 2013 October 1,

4 QHP/QDP Certification Criteria Status April 1, 2013 April 1 - July 31, 2013 July 19, 2013 Issuer Submission Form 1 - Certificate of Good Standing OIC Regulatory Process 4 - Market Rules Participation Agreement 2 - User Fees 6 - Accreditation 5 - Non-discrimination 3 - Risk Adjustment Program 8 - Network Adequacy 7 - Marketing Requirements 13 - Standard Enrollment Form 14 - Hospital Contracts 15 - Direct Primary Care w/qhp Issuer, if any 16 - Benefit Design Standards 17 - Rates and Service Area 19 - benefit and rate data for public disclosure 9 - Provider Directory Data 10 - Quality Improvement Strategy 11 - Standard Summary of Benefits & Coverage (SBC) Future Years: 12 - Quality & Performance Measures 18 - Premium Increase Justification = not needed for

5 Certification for Individual Exchange Market Refer to individual market packet Board review and discussion Vote for certification of recommended plans 5

6 Certification for SHOP Market Refer to SHOP market packet Board review and discussion Vote for certification of recommended plans 6

7 What Happens Next? Issuers sent Certification notice and bug to use for marketing purposes. Washington OIC notified and each certified plan updated in the SERFF system with the certified status. CMS/CCIIO pull data from SERFF on August 31, 2013 to begin their financial analysis and calculations. WAHBE loads all certified plans into the Plan Management system and Bluecrane Solutions performs QA services. Issuers perform production data validation on September 10 th to enable plan publishing for October 1,

8 Washington Health Benefit Exchange Questions?

9 Appendix 9

10 Plan Management QDP Timeline Event Due Date Letter of intent to participate in Healthplanfinder January 22, 2013 P HBE issues Final Guidance for Participation of Dental Plans HBE and OIC perform QDP certification and regulatory review processes HBE issues Final HBE Participation Agreement for Dental Issuers QDP issuers satisfy any remaining QHP certification criteria to HBE staff March 1, 2013 February 1, 2013 July 31, 2013 June 10, 2013 August 9, 2013 P P P P HBE Board certifies QDPs for 2014 August 21, 2013 Board meeting P QDP issuers ratify QDP benefit and rate data in HBE Healthplanfinder system QDPs available in Healthplanfinder for an initial effective date of January 1, 2014 September 10 & 11, 2013 October 1,

11 Issuers included in Certification Packet Individual BridgeSpan Health Group Health Cooperative LifeWise of Washington Premera BlueCross SHOP Kaiser Northwest Dental Delta Dental of Washington Kaiser Northwest LifeWise of Washington Premera BlueCross 11

12 Issuers Continuing to Seek Certification in WAHBE Individual Community Health Plan of Washington Coordinated Care Kaiser Northwest Dental Dental Health Services Willamette Dental 12

13 Affordable Care Act Terminology Illustration Issuer Product Product 1 Issuer Product 2 Plan Plan 1 GOLD 80%AV Plan 2 SILVER 70%AV Plan 3 Plan 4 CSR Variation AI/AN Zero Cost AI/AN Limited Cost AI/AN Zero Cost AI/AN Limited Cost 73% AV 87% AV 94% AV Product defines benefit coverage, formulary, provider network Plan defines cost sharing and premium levels within Product CSR Variation defines mandated cost sharing reductions with no change in premium QHP Certification is issued at the Plan Level, based on criteria from Issuer, Product, and Plan Levels combined. AV = Actuarial Value AI/AN = American Indian/Alaska Native CSR = Cost Sharing Reduction 13