Welcome & Minutes Approval Michele Eberle, MHBE Plan Management - - PowerPoint PPT Presentation

A service of Maryland Health Benefit Exchange

Welcome & Minutes Approval

Michele Eberle, MHBE Plan Management

A service of Maryland Health Benefit Exchange

Exchange Implementation Advisory Committee Briefing

February 5, 2015

Enrollment

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• Over 200,000 enrolled through Maryland Health Connection

with 2 weeks remaining in 3-month open enrollment.

• Includes over 100,000 so far in qualified health plans. Last

year, 63,000 enrolled in QHPs during 6-month open enrollment.

• Over 95,000 newly enrolled in Medicaid.
• Across the US, 9.5 million people have selected a plan or

were automatically enrolled.

• Both nationally and in Maryland, about 87% of applicants were

determined eligible for financial assistance, up from 80% a year ago.

Marketing

• 1 million+ unique visitors to MHC.gov since beginning
• f open enrollment.
• 20,000+ receiving weekly MHC e-mail updates.
• Launched outreach and advertising partnerships with

Afro-American newspaper and Entravision Spanish broadcasting to help spread message and materials to black and Hispanic audiences.

• 34% of MHC website visitors come via Google search.

Using social media to drive conversation to site to build

• ur online authority and profile.

Marketing

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TV, radio, print, transit, digital advertising: 190 million impressions

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• Young people (ages 18-34)

comprise 30% of Md. enrollment so far, in line with national trend.

• Strategic approach taken in

selecting digital outlets (online apps, Facebook, Pandora) to reach “Young Invincibles.”

• Turning testimonial videos

into YouTube ads to drive more online traffic. Outreach -- Young Invincibles

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Enrollment By Carrier

Open Enrollment 1 (thru 9/30/2014)

• 1. CareFirst: 76,835
• 2. Kaiser: 3,853
• 3. Evergreen: 563
• 4. United Healthcare: 302

Open Enrollment 2* (thru 2/3/2015)

• 1. Carefirst: 80,753
• 2. Kaiser: 12,947
• 3. Evergreen: 2,418
• 4. United: 2,100
• 5. Cigna: 290
• 6. All Savers: 522

*Ends 2/15/2015

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Enrollment By Plan Silver, 61%; Bronze, 23%; Gold, 9%; Platinum, 5%; Catastrophic, 2%

Final Stretch

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• Adam Jones radio commercial

for stretch run in February (Maryland Citizens’ Health Initiative) to help reach “Young Invincibles.”

• Statewide community college
• utreach on National Youth

Enrollment Day last week.

• SMS texting (to emphasize

deadline and penalty, in “countdown” style at the 4, 3, 2 and 1-week marks).

Online resources

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Resources are available for download at

MarylandHealthConnection.gov

• n the Download Center page

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Additional messages With enrollment progressing, we’re now expanding messaging to include:

• Making consumers more

aware of penalty for failing to have coverage;

• What to do after

enrolling;

• How to manage health

care and coverage.

since Nov. 15, providing information and enrollment assistance.

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Connector Entities

• Six Connector Entities with over 300 certified

navigators and assisters.

• Our “Boots on the Ground”: Have interacted with 35,000+

Marylanders, providing information and enrollment assistance.

• Holding over 20+ Enrollment Fairs throughout the State

during open enrollment.

• Connector Entities developed “Store Front” enrollment sites

to allow consumers convenient access to in-person enrollment assistance in their communities.

• 30 enrollment sites in 19 counties; sites in remaining counties

co-located in other organizations.

• Innovative activities, e.g. enrollment days on Smith Island with

DNR providing boat transportation; partnerships with One- Stop Job Centers and public libraries.

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Connector Entities

• CSC managed by Maximus; Maryland-based call

center located in Baltimore and Baltimore County.

• Over 300 certified Call Center workers and support

staff; state-of-the-art call telephony system.

• Call center utilization:
• Total calls offered - 308,399
• Average handle time - 17:22.
• Level II Help Desk: specialized team to assist call

center agents, navigators and assisters

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Consumer Support Center (CSC)

• Insurance producers have been valuable partners in

supporting consumers’ enrollment.

• 900 producers authorized in individual marketplace;

1,000 in SHOP.

• Have enrolled 9,000 households so far for 2015 plan

year.

• Continued partnership with Broker Referral Program

established during last open enrollment.

• Pivotal role in providing assistance to 2014 enrollees

who need to re-enroll in new system.

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Insurance Producers and Broker Referral Program

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Other Consumer Assistance

• Application Counselor Program: 35 sponsoring

entities and 183 certified counselors

• MHBE Constituent Services

○ Established beginning of open enrollment ○ 213 cases received, with about 40% still in process

• Appeals and Grievances Unit

○ 2,109 cases filed; ○ 2,049 resolved before hearing scheduled; ○ 41 hearings scheduled; ○ 35 cases resolved informally before hearing.

Gains Across Maryland

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• Reductions in uninsured: Baltimore, Carroll,

Harford, Howard, Montgomery Prince George’s and Worcester counties are among places where 2015 enrollments trending above their percentage of uninsured based on 2012 Census data.

• Opportunity for Growth: Lower Eastern Shore and

Western Maryland are among the areas with the largest percentages of all nonelderly uninsured (12%- 16%) and greatest potential for benefit for financial assistance for coverage.

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Enrollment By Jurisdiction

• Md. Uninsured Likely Eligible

for Subsidies

2012 Small Area Health Insurance Estimates (SAHIE), U.S. Census Bureau 19

2012 Small Area Health Insurance Estimates (SAHIE), U.S. Census Bureau 20

• Md. Uninsured Likely Medicaid Eligible

More maps posted at marylandhbe. com/maps

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Net Familiar: 39%↑

• Vs. 9% ‘13

Favorable 48% Unfavorable 20%

• Vs. ‘13

19%

• Vs. ‘13

40%

↑ indicates increase vs Q3 2013 Q24: [N=800] How familiar are you with Maryland Health Connection? Q25: [IF Q24=1-3; N=424] Based on anything you may have seen or heard, are you favorable, unfavorable or neither favorable nor unfavorable towards the “Maryland Health Connection”? Is that very or somewhat favorable/unfavorable?

Maryland Health Connection earned positive familiarity over the past year across the state. Only a small portion of those aware of it hold negative sentiment.

Uninsured: 39% vs. 5% in ‘13 Favorable 78%

• Vs. ‘13

39% Uninsured

Public Opinion: Favorability

August 2014 research by KRC Research

Focus groups conducted Oct.-Nov. 2014 for Maryland Citizens' Health Initiative Education Fund:

• “Awareness of MHC varied greatly. Two groups (Easton and Suburban

Baltimore) exhibited absolutely no awareness of Maryland Health Connection – nor of the impending open enrollment on November 15. They did have a high awareness of the Affordable Care Act, and most were aware of their obligations to enroll in coverage or face a penalty.”

• “Several other focus groups exhibited strong knowledge of Maryland Health

Connection and the enrollment process. Two examples of this higher awareness were in Columbia and Suburban Washington. Several people credited the news media, and particularly talk radio aimed at the African- American community, with keeping them informed of their rights and

• bligations under the law.”

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Public Opinion: Awareness

January 2015 research by OpinionWorks

Helping Consumers with Tax Filing

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• Form 1095-A provides information about Advanced

Premium Tax Credit (APTC) paid during 2014 to eligible consumers to reduce monthly premium. It also lists each member of household on a QHP.

• Each tax household with 2014 QHP coverage will receive

a 1095-A from MHBE.

• 1095-A information necessary for consumers to complete

tax returns. MHBE reports same information to IRS.

• For 2014 tax year only, 1095-As will not be system-
• generated. Forms will be mailed by Jan. 31.

Helping Consumers With New Tax Form

• Consumers who believe information on their Form

1095-A is incorrect will be directed to call the CSC (1- 855-642-8572).

• IVR Option will route consumers to specialized team

to work with consumers.

• Call center agents will provide information to analysts

who will investigate reported error. If information is incorrect, a correct Form 1095-A will be generated.

• Corrected forms will be batch-generated and mailed

(frequency will depend on volume)

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Form 1095 - Form Corrections

Small Business

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• SHOP Direct Enrollment: allows small business owners to offer health

insurance through employer choice and to access tax credits. It has been available through SHOP-approved brokers since April 2014.

• Employee choice: As of Jan. 1, small business owners can also offer

insurance through employee choice, as well as access small business health care tax credits.

• TPA-administered: We have identified three third-party administrators to

help business owners with <50 full-time employees enroll.

• Aggregate billing: Small businesses with <50 full-time employees enjoy the

benefit of aggregate billing -- single bill for employee premiums regardless of the number of insurance companies they choose, plus flexibility to adjust how they contribute to employee premiums.

• Tax Credits: Small businesses with <25 full-time employees will be eligible

for a tax credit for two consecutive years before they need to reapply.

Small Business Health Options Plan

Small Business

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• Shopping available April 1, 2014 for June 1st coverage.
• Federal tax benefit made available for qualifying employers.
• “Direct enrollment” process
• Employer choice model only – employers chose one carrier and offer one
• r more Exchange certified SHOP plans from that carrier;
• Exchange determined employer eligibility to participate in SHOP program;
• Exchange reported enrollment information to CMS and IRS;
• Brokers worked directly with carriers and/or third party administrators.
• SHOP certified plans

○ Total Applications approved 139 ○ Enrolled Employees & Dependents 228 ○ Group size less than 10 employees 86% ○ Group size 11-20 employees 9%

2014 SHOP Program

Small Business

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• “Direct enrollment” to continue for Employer Choice model

○ Exchange/TPA determines employer eligibility to participate in SHOP program; ○ Exchange reports enrollment information to CMS and IRS; ○ Brokers work directly with carriers and/or third party administrator to sell ○ SHOP certified plans.

• Employee choice model will be available through MHBE contracted third-

party administrators ○ Employee choice model – employers choose one metal level and offer one

• r more Exchange-certified SHOP plans from all carriers in the metal level;

○ Shopping available January 1, 2015 for March 1st coverage; ○ Exchange reports enrollment information to CMS and IRS; ○ Brokers work directly with carriers and/or third party administrator to sell SHOP certified plans.

• Federal tax benefit and employee choice model made available for

qualifying employers.

2015 SHOP Program

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IT System - Summary

• The MD-HBX system has helped enroll over 190,000

people for the 2015 enrollment period to date.

• The current MHBE IT Team will continue to support the

system for 2015 enrollment period and ongoing operations.

• Robust incident response protocols are in place to address

any system anomaly.

• Continuous improvement processes are in place and is a

priority for the MHBE IT team.

• Continue compliance with evolving ACA requirements and
• ur federal partners CMS / CCIIO.

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IT Work Streams

Operations & Incident Mgmt.

• Database Management
• Batch Management &

Support

• System Health Checks &

Monitoring

• File Management
• DR Support
• System Patch and Upgrade

Management

• Security Support
• Provide daily batch/
• perational report
• Processes in place to rapidly

respond to incidents and communicate any system impacts to stakeholders Maintenance

• Perform Maintenance &

Operations

• Perform Configuration

Management

• Provide Reporting Support
• Perform Software Upgrades
• Perform Data Fixes
• Analyzing and developing

solutions for system defects as they arise

• Periodic maintenance

releases monthly

• Examples include

performance enhancements, security patches, software upgrades Enhancements

• Prioritize and Develop Level
• f Effort Estimates
• Requirements Definition
• Enhancement Design
• Enhancement Development
• Enhancement Testing &

Implementation

• Examples include

development of Form 1095-A generation, renewals, and Medicaid redeterminations

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2015 IT Roadmap

2014 2015 Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Decommission Legacy HIX System Enhancements 1/15 - 9/30 2015 Open Enrollment 11/15 - 2/15 Code Freeze & 2016 OE Prep. 10/1 - 10/14 9/15 Load 2016 Plans 3/31 10/15 - 12/7 Regular Maintenance Releases 2016 Open Enrollment 12/15 - 9/30

Activities

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System Enhancement Key Functionality

• Enhancement Release 1

Renewals The 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 (if eligible). This functionality provides a centralized means for consumers, workers, and carrier transactions that is familiar to enrollees and power users alike and reduces the steps needed to renew coverage.

• Enhancement Release 2

1095-A The 1095-A reporting functionality reduces the burden of manual processing and allows MD HBX to remain in compliance with IRS reporting standards. This functionality provides a centralized means for consolidating and processing the data required for compliance. Performance Enhancements Increasing worker efficiency will allow workers to be more productive by processing more applications in the same time Providing a better user experience for the customer will generate positive feedback and more acceptance of the Maryland HBX application. MABS & Work Number Interfaces We will create a new interface with MABS and Work Number. The call will be initiated if FDSH returns “Income Not Verified”. The system will trigger a VCL if FDSH, MABS and Work Number all return “Income Not Verified”. If VAHI service returns “Verified”, MABS and Work Number will not be called.

Regulatory Update

• MHBE has 6 regulations currently published in the Maryland

Register for public comment. Regulations were previously submitted to Senate Finance for review in 2014.

1) Training & authorization requirements for captive producers; 2) Training & permit standards for consolidated service center employees; 3) Appeals from producer authorizations and individual exchange navigator certifications; 4) Fair hearings process for individual exchange eligibility determinations; 5) Standards for designation of application counselor sponsoring entities 6) Training and certification requirements for application counselors.

You are cordially invited to attend one of the upcoming HealthConnectNow! enrollment fairs. More than 20 fairs have been held across the state most weekends since mid-November, drawing about 2,000 Marylanders for free, in- person help with enrollment. Saturday, February 7

• 10 am to 4 pm, Baltimore Convention Center, 1 W. Pratt

St., Baltimore, MD 21201

• 10 am to 2 pm, Wicomico Youth & Civic Center, 500 Glen

Ave., Salisbury, MD 21804

• 10 am to 2 pm, Howard Community College, Duncan Hall,

Room 100, 10901 Little Patuxent Parkway, Columbia, MD 21044

Thursday, Feb. 12

• 2 pm to 7 pm, Holiday Inn Solomons Conference Center

and Marina, 155 Holiday Drive, Solomons, MD 20688 Upcoming Enrollment Fairs

A service of Maryland Health Benefit Exchange

Plan Management

MHBE Plan Management

Tobacco Rating for 2016

2015 HBX status: not available

– Identified as a major missing plan management functionality in gap analysis – Carrier partners unable to engage in tobacco rating

2016 HBX status: not available

– Identified as a major missing plan management functionality – Queued in the work management plan for future development – Carrier partners will be unable to engage in tobacco rating

Stand alone dental plans for 2016

2015 HBX status: not available

– Identified as major missing plan management functionality in gap analysis – Participating SADP direct enrollment sites are linked from the application

2016 HBX status: not available

– Identified as major missing plan management functionality – Queued in the work management plan for future development – Participating SADPs must continue to use direct enrollment

Premium Tax Credit and non-Federal EHBs

2015 HBX status: currently not available

– Fix to be dropped in the April 15th release

Business Rule: If an enrollee selects such a QHP, the HBX will separate out the premium portion that applies to the Federal EHBs from the premium portion for non-expected abortion services and non-Federal EHBs and apply APTC only to the premium for the Federal EHB.

EH EHB% for Plan = 99.33% Prem Premium um applicab cable f e for

• r EH

EHB S Ser ervice ces = Total Premium * EHB% = (200*99.33%) = $198.66 Ma Maximum um a applicab cable AP APTC TC = Premium applicable for EHB Services = $198.66 Prem Premium um Amo Amoun unt d t due f e for

• r Ab

Abor

• rti

tion S

• n Servic

rvices = (Total Premium – Max APTC applicable = (200.00 - 198.66) = $1.33

2016 Plan Certification Process

Proposed Timeline

March 2015

2016 Plan Certification Standards Finalized 2016 Notice of Payment Practices sent to carriers MIA benefit & rate submissions completed Plan Certification Materials to carriers

• Template

Guide

• Certification

Checklist

• Open

Enrollment Checklist

MIA Approvals completed Templates loaded to SERFF MHBE plan certification complete HBX system testing complete 2016 OE begins

Feb Mar Feb 28 Mar 15 May 1 May 31 Aug 30 Sep 4 Sep 11 Sep 15 Oct 1

A service of Maryland Health Benefit Exchange

SHOP Update

Michele Eberle, MHBE Plan Management

SHOP Updates

Direct Enrollment Process for Employer Choice option Employee Choice option progress Full integration for 2016 timeline

A service of Maryland Health Benefit Exchange

2014 Renewals Update

Nabila Rahman, Optum Catherine Griffin, Optum

A service of Maryland Health Benefit Exchange

HBX Items

Dennis Glorioso

Public Comments?

Next Meeting: February 19th, 2015 Comments: mhbe.carriers@Maryland.gov