Maryland Health Benefit Exchange Web-Based Entities May 14, 2013 A service of Maryland Health Benefit Exchange
Agenda Agenda • Policy Introduction; • Federal and State Considerations; • Public Comment; • Staff Considerations; and • Recommendation. 2
Policy Introduction
Policy Discussions Issue: What process should the Maryland Health Benefit Exchange undertake to determine whether to partner with a web-based entity(WBE)? WBEs are defined as producers that offer health insurance options primarily through a Web portal. A number of WBEs have expressed interest in working alongside State-based Exchanges (SBEs) to enroll subsidy- eligible individuals into Qualified Health Plans (QHPs). WBEs may help enroll Marylanders, a key goal of MHBE. 4
Federal and State Considerations
Federal Law The March 2012 federal Exchange rule provides for the use of WBEs: A WBE cannot independently perform eligibility determinations as part of enrollment; and In order to enroll in a QHP, an individual must complete the streamlined application described in 45 CFR 155.405. 6
Federal Law March 2012 federal Exchange rule provides that a WBE must: Meet all standards for disclosure and display of QHP information; Provide consumers the ability to view all QHPs offered through the Exchange; Not provide financial incentives, such as rebates and giveaways; Display all QHP data provided by the Exchange; Maintain audit trails and records in an electronic format for a minimum of ten years, and Provide consumers with the ability to withdraw from the process and use the Exchange Web site at any time. 45 CFR § 155.220(c)(3) 7
Federal Law On May 1 st CCIIO issued FAQs on the role of agents, brokers and web-brokers in health insurance marketplaces, which indicated: SBEs may work with Web-brokers; and CMS is developing the capability to support integration between a web- broker’s website and the FFE’s website using secure redirect and application programming interface mechanisms. In addition to the minimum requirements set out in the final Exchange rules (45 CFR § 155.220(c)(3)), the FAQs indicated that a web-broker partnering with the FFE must: – Securely transmit and receive QHP, eligibility and enrollment information between the FFE and the web-broker; – Meet all existing and future HHS privacy and security standards; – Authenticate consumer identification; – Comply with State appointment requirements; – Refrain from steering consumers to specific plans; – Disclose compensation; – Offer a QHP shopping experience free of non-QHP advertising; – Provide quality information on each QHP; and 8 – Provide all required disclosures.
State Considerations State Concerns: Policy: (Consumer Value) – What advantages for consumers do WBEs offer? – Should the MHBE require that WBEs offer additional services to consumers beyond those offered through Maryland Health Connection? (Consumer Protections) – Are federal requirements sufficient to protect consumers? – Should the MHBE consider additional requirements in the areas of (a) marketing; (b) disclosures; (c) referral for individuals who may be eligible for Medicaid; (d) referral to connector entities or the Consolidated Service Center(CSC); (e) conflict of interest; or (f) other areas? – What training requirements, if any, should apply to (a) licensed producers working for the WBE; or (b) other WBE staff working in roles with direct contact with Marylanders? 9
State Considerations State Concerns: Technical: – What is the simplest and most effective way for a WBE to integrate its system into Maryland Heath Connection in order to meet federal requirements? Please be specific about technical requirements? Logistical: – Should the MHBE choose a restricted number of WBE partnerships or set minimum criteria for partners and allow all to participate? If a restricted number, how should the MHBE fairly choose WBEs for partnership? – How should the MHBE enforce federal and other requirements set for WBEs? 10
Public Comments
Request for Public Information Action Since Last Board Meeting: March 12 th : The MHBE Board recommended seeking public comment on the policy, technical and logistical issues of partnering with a WBE. March 16 th : A request for public information (RFI) was posted on the MHBE website soliciting public comment on WBEs in the areas of: – Policy (Consumer Value and Protections); – Technology (Access to Maryland Health Connection); and – Logistics (Participation and Enforcement). March 29 th : The RFI comment period closed and the MHBE received comments from 37 individuals representing 41 different interest and organizations. 12
Summary of Public Comments Overall Points: 67% of commenters were apprehensive about the MHBE partnering with a WBE with five completely opposed and ten calling for a delay of a year or more or at least assessing the success of navigators and producers; Many commenters were concerned with WBEs ability to provide the personalized services necessary to help Marylanders select a qualified plan; While many commenters were concerned with the MHBE’s ability to oversee WBEs with little physical presence in the State, there was near unanimous agreement that the State(MIA & MHBE) should regulate WBEs; and Many commenters agreed that WBEs needed unique conflict of interest standards. 13
Summary of Public Comments Policy: Consumer Value: 62% Found Little to No Advantage to WBEs: Overly simplistic model; Impersonal; Create consumer confusion; Disrupt market; and Dilute Maryland Health Connection brand. To Protect Consumers, Additional Services Recommended Include: Call center staffed with licensed professionals; Resource page; and Search tools. 14
Summary of Public Comments Policy: Consumer Protections: 48% of Commenters indicated federal requirements were insufficient to protect consumers. Additional requirements include: Maryland licensure and consent to MIA/MHBE jurisdiction, Bonded in Maryland; Partner with a local broker and/or have a physical presence in Maryland; Marketing materials provide clear disclosures and limitations on advertising; Disclosure of compensation, revenue and expenses for the past 10 years; Clear referral instruction for Medicaid enrollees; Inform enrollees they can get assistance from the CSC/Connector Entity; Prohibition on steerage; Clear conflict of interest policy; Strict protection of consumer privacy; Preferences/filters should only be selected by the consumer; Prohibition on discrimination; and 15 Collect data for the MHBE and report regularly.
Summary of Public Comments Policy: Licensure & Training of WBE Personnel: Producers: 65% of Commenters Recommended Licensure & Training, Including: – Training on Maryland health insurance law; HIPAA; COBRA; affordability programs; metal levels; allowable premium variations; Medicaid and CHIP; privacy standards; tools and technical assistance; individual market reforms; QHPs, APTC and CSR; annual renewal information; qualifying events; and handoffs to Medicaid, CSC, Navigators, producers and MHBE. – 2 years’ experience in Maryland prior to certification; and – Errors and omissions insurance. Non-Producers: Call center employees and others who have contact with consumers must have at least the same level of training as their counterparts in the Exchange, ie CSC permitted 16 employees, certified navigators, etc.
Summary of Public Comments Technology: Commenters Suggestions on the simplest and most effective way for a WBE to integrate into Maryland Heath Connection: iframe: – Frame through which data can securely pass, – Methodology to recognize WBE as Broker of Record – Method established by the State to provide QHP data. – Limits include: limit shopping to QHPs, designed to run smaller applications, may not provide secure technology architecture to fully protect the HIX from outside control or manipulation. Direct Integration Into Maryland Health Connection: – Complex and could potentially place a heavy burden on the MHBE IT staff. 17
Summary of Public Comments Logistics: Commenters Recommended a Range of Possible Levels of Participation: 10 commenters recommended the State accept any WBE meeting minimum criteria; 6 commenters recommended no WBEs; 3 commenters preconditioned a partnership with a WBE on the failure of Navigators/outreach entities(ie determine the success of the current outreach entities prior to allowing WBEs in later years); 1 commenter recommended a single entity; 1 commenter recommended going through vetting process to test the theory of WBEs with several candidates; and 1 commenter suggested limiting the number of WBEs to State’s ability to perform oversight. 18
Summary of Public Comments Logistics: Commenters Suggested Several Means of Enforcement: Oversight by the MIA/MHBE; Enforcement should mirror that of any other vendor or provider; Data collection, analysis and documentation; Annual review of marketing approaches to ensure no steering; Review portal changes in the event a WBE altered its system Compliance monitoring and audit processes; Agreement formalizing the WBE’s commitment to adhere to maintain minimum enrollments in QHPs, acceptance of the WBE as a producer by all carriers, quality controls, submission of all training materials, adherence to documentation requirements and compliance with all Maryland laws and regulations; and “Three strikes and you are out” approach. 19
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