Welcome & Minutes Approval February 19 th , 2015 Michele Eberle, - - PowerPoint PPT Presentation
Welcome & Minutes Approval February 19 th , 2015 Michele Eberle, MHBE Plan Management Subi Muniasamay, CIO A service of Maryland Health Benefit Exchange 2015 Open Enrollment Update Michele Eberle, Director PPM A service of Maryland Health
A service of Maryland Health Benefit Exchange
Welcome & Minutes Approval
February 19th, 2015 Michele Eberle, MHBE Plan Management Subi Muniasamay, CIO
A service of Maryland Health Benefit Exchange
2015 Open Enrollment Update
Michele Eberle, Director PPM
Call from CMS to allow individuals additional time to complete enrollment based on overwhelming response and impact to call centers and systems All SBMs agreed to consider, all but three states — Hawaii, Kentucky and Vermont — had announced extensions by Monday afternoon Maryland agreed to allow anyone who was unable to complete their application by midnight on 2/15 until 2/28 to complete enrollment
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Open enrollment to buy a plan for 2015 ended Feb. 15, 2015. However, Maryland Health Connection is allowing people to complete their enrollments until
have contacted the call center at 855-642-8572 by Sunday, Feb. 15, to be able to complete the process by Feb. 28. The online application will allow you to check a box to confirm you tried to enroll by the Feb. 15 deadline but were not successful, and you will be able to complete your enrollment by Feb. 28, 2015. If you enroll in a qualified health plan by Feb. 18, your coverage begins March 1, 2015. If you enroll in a QHP from Feb. 19 to Feb. 28, your coverage begins April 1, 2015. Enrollees would not be subject to the federal tax penalty, which allows an exemption for three months without coverage during the calendar year. Enrollment continues year-round at MarylandHealthConnection.gov for people who are eligible for Medicaid. You may also be able buy a plan outside of open enrollment if you have special circumstances such as having a baby, getting married or losing other health coverage. Open enrollment for 2016 begins this fall.
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What the Website says
269,062 enrolled through MarylandHealthConnection.gov 84,790 QHP with an APTC
– 32% total QHP and Medicaid enrollments – 71% total QHP enrollments
34,986 QHP w/o an APTC
– 13% total QHP and Medicaid enrollments – 29% total QHP enrollments
149,286 Medicaid enrollments
– 55% total
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By the Numbers
A service of Maryland Health Benefit Exchange
IT Updates Implementation Advisory Committee Meeting
February 19, 2015 Presented by: Subramanian Muniasamy CIO, MHBE
CIO Introduction IT Overview M & O Releases Planned Improvements Q & A
Agenda
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CIO Introduction
Facilitated Marketplace (FFM)
Documents (ESMD) program for CMS
Ownership System (PECOS) program for CMS
integrated eligibility (MA, SNAP, Cash and CHIP) solutions for the State of New Hampshire (NH) and Commonwealth of Pennsylvania (PA)
Solution in 7 months as the key management leader from Deloitte Consulting
system as the Director from Optum/QSSI
Subramanian Muniasamy
Chief Information Officer Joined MHBE on January 07, 2015
Executive summary
building systems for Health and Human Service programs like Medicaid, Cash, SNAP and CHIP
having provided leadership on several high profile large-scale IT programs for State and Federal Government Prior Positions
Education
Communications
MD HBX Experience State & Federal Govt. Experience
IT Overview
M&O Releases Special Projects
Approximately 35% of base applications, 20% of security and 20%February April June Requirements Design / Development Testing Implementation Requirements Design / Development Testing Implementation Requirements Design / Development Testing Implementation Lower Environment Migration 1095 & MA Database Transition Legacy HIX Decommissioning Other Items
Documentation supplied by QSSI and is currently under review by Deloitte Table schema will be developed once review is complete Approximately 50% of the Dev/Test servers have been powered off (65Enrollment Overview
Complete On-Track Planned At RiskEnhancements
July September Requirements Design / Development Testing Implementation Planning Requirements Design / Development Testing Implementation Planning Status Status Functionality Functionality
Renewal functionality reduces the burden of manual renewal processing and allows consumers to choose whether to actively extend existing coverage, change coverage, or be auto-assigned a new program/coverage group. 1095-A reporting functionality reduces the burden of manual processing and allows MD HBX to remain in compliance with IRS reporting standards.August Requirements Design / Development Testing Implementation Planning Planning Planning Planning January Requirements Design / Development Testing Implementation Planning MHBE Network Upgrade
Enhancement to the MHBE VPN, active directory, telephone etc..9 Medicaid 149,286 55% APTC 84,790 32% QHP 34,986 13%
January Release
updates, and updated special enrollment business rules February Release
updates, update language preferences for brokers April Release
verification interface, carrier template, SBC updates, and 2015 FPL update
M&O Releases
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Planned Improvements
# Enhancement Items Regulatory Requirement Operational Efficiency Business Excellence
1 PARIS Interface 2 Auto Enrollment of Medicaid Age-Out Population 3 Emergency Medicaid 4 ECMS/ FileNet Integration 5 CMS 834 Integration Readiness 6 Transitional Medicaid 7 Dental Plans 8 Tobacco Ratings 9 Removal of IDB
PARIS – Public Assistance Reporting Information System ECMS – Enterprise Content Management System IDB – Interim Database
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A service of Maryland Health Benefit Exchange
2016 SERFF Template Changes
JP Cardenas, MHBE PPM
2016 SERFF Template Changes
The fields HSA Eligible, HSA/HRA Employer Contribution, and HSA/HRA Employer Contribution Amount have been moved from the Benefits Package worksheet to the Cost Share Variances worksheet where they can now be completed for each plan variation. For SHOP Plans – Does this plan offer Composite Rating? Individual plans will auto-populate “No” Child Only Plan ID – no longer required for catastrophic plans Disease Management Programs Offered (optional) – Weight Loss Programs added as a new drop-down option for the 2016 plan year EHB Percent of Total Premium (required) – for on-Marketplace plans abortion services must be excluded from the EHB proportion. Used for subsidy calculation
Plans & Benefits Template – Plan Attributes
2016 SERFF Template Changes
URL for Summary of Benefits & Coverage and Plan Brochure now moved to the Cost Share Variances worksheet. URL for Enrollment Payment (optional) – a link connecting the consumer to a carrier’s payment portal. Please submit formal comment to mhbe.carriers@maryland.gov describing interest in display.
Plans & Benefits Template – URLs
2016 SERFF Template Changes
Benefit Explanation (optional) – If edited an EHB variance reason is no longer needed. Subject to Deductible [Tier 1 and 2] – removed from Plan and Benefits Template for the 2016 plan year. AVC will use actual copay and coinsurance drop down values. SBC Scenarios – the fields in this section are now required for QHPs Maximum Out of Pocket and Deductibles – may now allow for per-group or per-person distinctions, i.e. stacked deductibles Cost-sharing fields – “Not Applicable” an option for all fields
Plans & Benefits Template – General Information, OOP Exceptions, SBC Scenario, Cost Sharing
2016 SERFF Template Changes
New Drug Tier Types - “Specialty Drugs,” “Zero Cost Share Preventive Drugs,” and “Medical Service Drugs”
Brands” Pharmacy Cost Sharing Types Columns removed (G, K, O, and S on Formulary Tiers sheet) Copayment and Coinsurance options will align with options on the PBT Copayment and Coinsurance now allowable up to two decimal places Copayment and Coinsurance auto-restraints when selecting ZCS Preventive Drugs and Medical Service Drugs
Prescription Drug Template – Drug Tier Type and Tier Cost Sharing
A service of Maryland Health Benefit Exchange
2016 Plan Certification Standards
Michele Eberle, Director PPM
CMS released on 12/19/2014, a draft annual letter to FFM carriers setting forth proposals for 2016 plan certification standards. CMS has not released the Final 2016 Letter to Issuers, nor finalized the HHS Notice of Benefit and Payment Parameters for 2016. Proposed 2016 standards for federal marketplace are substantially similar to 2015 standards, and most of the recommendations for MHBE 2016 standards remain the same as last year. MHBE will post its proposed certification standards for public comment for seven days on its website. Any changes in the final federal rules or public comment may result in a change to the MHBE 2016 Plan Certification Standards.
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2016 Proposed Plan Certification Standards
Network Adequacy
Proposed 2016 Certification Standard (Substantially similar to 2015 federal standard except where noted in red) MHBE Proposed Recommendation (Substantially similar to 2015 MHBE standard except where noted in red)
Plans must submit complete provider lists that include all in‐network providers and facilities for all plans for which QHP certification is
accurate, and complete, including information regarding which providers are accepting new
the directory information on their website in a machine‐readable file and format specified by HHS.
MHBE should continue current requirements that plans submit provider lists to CRISP . The provider list should be current (at least twice a month), accurate, and complete. MHBE may also require the provision of directory information on issuer websites in a machine‐ readable file.
Drug formulary Internet link provided by plans must link directly to list of covered drugs without requiring further navigation, and must include tiering and cost‐sharing. The formulary drug list URL must be up‐to‐date, accurate, and complete.
Drug formulary Internet link provided by plans must link directly to list of covered drugs without requiring further navigation, and must include tiering and cost‐sharing. The formulary link must be up‐to‐date, accurate, and complete.
Network Adequacy
Proposed 2016 Certification Standard (Substantially similar to 2015 federal standard except where noted in red) MHBE Proposed Recommendation (Substantially similar to 2015 MHBE standard except where noted in red) Issuers must create a drug exception process for standard situations (in contrast to exigent circumstances) by which an enrollee can request access to a drug not
notify the enrollee of its coverage decision no more than 72 hours after receipt of the exception request. Issuers must have an external review process conducted by an independent review organization for denied requests. Issuers must create a drug exception process for standard situations (in contrast to exigent circumstances) by which an enrollee can request access to a drug not on the plan’s formulary. The issuer must notify the enrollee of its coverage decision no more than 72 hours after receipt of the exception request. Issuers must have an external review process conducted by an independent review organization for denied requests.
Network Adequacy
Proposed 2016 Certification Standard (Substantially similar to 2015 federal standard except where noted in red) MHBE Proposed Recommendation (Substantially similar to 2015 MHBE standard except where noted in red) Certain QHP issuers must comply with standards and requirements related to quality reporting through the implementation of the Quality Rating System (QRS) and the Enrollee Satisfaction Survey (ESS). HHS will implement the QRS and ESS system including setting standards and calculating scores and ratings. HHS is implementing these national quality reporting systems in a phased approach. For 2016, certain QHP issuers must attest that they have complied with the specific quality reporting and implementation requirements. Certain QHP issuers must comply with the federal standards governing QRS and ESS Survey information. Issuers are also required to continue to provide quality data and Race, Ethnicity, Language, Interpreter Need, and Cultural Competency (RELICC) data to the Maryland Health Care Commission (MHCC).
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Presentation to MHBE Board of Trustees canceled due to State closure on 2/17/15 MHBE to post ‘proposed standards’ for comment Expect comment period to end 3/1/15 Waiting on CMS final rule to publish MHBE final standards
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By the Numbers
A service of Maryland Health Benefit Exchange
SHOP Update
Michele Eberle, Director PPM
Public Comments?
Next Meeting: March 5th, 2015 Comments: mhbe.carriers@Maryland.gov