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Maryland Health Benefit Exchange Implementation Advisory Committee Meeting August 7, 2014

Maryland Health Benefit Exchange Implementation Advisory Committee Meeting August 7, 2014. Welcome & Approval of Minutes. Michele Eberle Acting Director, Plan & Partner Management Maryland Health Benefit Exchange. Producer Data Discussion. Christopher Yeiser Manger, Producer Operations

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Maryland Health Benefit Exchange Implementation Advisory Committee Meeting August 7, 2014

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  1. Maryland Health Benefit ExchangeImplementation Advisory Committee MeetingAugust 7, 2014

  2. Welcome & Approval of Minutes Michele Eberle Acting Director, Plan & Partner Management Maryland Health Benefit Exchange

  3. Producer Data Discussion Christopher Yeiser Manger, Producer Operations Maryland Health Benefit Exchange

  4. Producer Data – Legacy HIX During 2014 834 Enrollment File – 2 Data Elements • Broker Name • Broker National Producer Number (NPN) Broker File – 10-12 Data Elements • Plan was to send monthly • Only got sent once

  5. Broker Data 2014 Why we used NPN • Nationwide • Permanent • Not assigned by you or us • Not private, no HIPAA concerns • Easily cross-referenced with NAIC online tools

  6. Broker File - 2014 Agency Name if we had it NPN Broker Name and Contact Info Agency Tax ID if we had it

  7. Broker Data – 2015 Planning for Broker Data 2015 • 834, Deloitte spec – 3 data elements • Broker Name • Broker License Number (not NPN) • MHBE-assigned account number • Broker File • Scheduling/Frequency… first file Feb. 1? • Data Fields – Same fields as 2014? Add License No.? • Format – XML, CSV, other? • Where do we send?

  8. THANK YOU! Comments & Questions • Christopher YeiserManager, Producer Operations • christopher.yeiser@maryland.gov

  9. HIX System Updates Ryan Goold Program Management Office Maryland Health Benefit Exchange

  10. Carrier Relations – Existing System EDI Operations Status Major activities with carriers winding down • Life Events Testing – CareFirst done through Cycle 3, Evergreen not participating, UHC Kaiser in Cycle to targeted to complete 8/15/14 • Reconciliation – All to be delivered by tomorrow 8/8/14

  11. Carrier Relations – Existing System Life Event Operations Status Backlog Reduction • Life events that were reported since Jan 1- 45% have been processed Developed operational and technical processes • Outreach strategy • Policy for SEP • Outreach underway for aging out dependents

  12. SHOP Direct Enrollment Process Modifications Stephanie Lee Manger, Producer Operations Maryland Health Benefit Exchange

  13. MHC SHOP Direct Enrollment Policy & Procedure Key Updates • Procedure • Removed all reference to Third Party Administrator (TPA) as it relates to selling certified Qualified Health & Dental Plans. • Step 1a. Carriers identifies to the SHOP-authorized producer or employer certified QHP/QDP plans for sale on the SHOP Exchange and off the SHOP Exchange. • Step 6. The carrier has the employer and its employees complete a carrier- specific enrollment process and provide the employer with an exact premium quote. • Step 7. Third Party Administrator (TPA) for premium payment collection.

  14. MHC SHOP Direct Enrollment Policy & Procedure Key Updates (cont.) • Procedure • Step 11. Address (City, State and Zip Code) of the employee to be included as part of the monthly “snap shot file” membership file form carriers. • Step 12. If an employer group is listed on the carrier's membership file and MHBE does not have a completed application on file, MHBE will request the point of contact from the carrier. • Step 12. A letter will be mailed to the employer requesting they submit an application and inform them of the inability to receive tax credits without an eligibility determination from MHBE.

  15. Comments/Feedback • We welcome any comments/feedback by close of business Monday, August 11, 2014 to the following email address. MHBE.SHOP@Maryland.gov

  16. SHOP RFP & Renewal PlanUpdate & Next Steps Michele Eberle Acting Director, Plan & Partner Management Maryland Health Benefit Exchange

  17. SHOP RFP • RFP technical & oral presentations complete • Review committee final recommendation by Friday • Present to MHBE board August 19th • Meet with awardee(s) and commence planning • Establish working groups to address issues • TPA – MHBE interactions • Carrier – TPA interactions • Employer Eligibility determinations • Broker of Record / TPA changes • Appeals process & workflow • Reporting

  18. RENEWAL PLAN • Continued work with CMS to approve plan • Close to finalizing • Likely individuals who do not come back into the system to renew will be auto-renewed in an on-Exchange plan withoutAPTC or CSR • Understand need to complete and publish the final renewal plan

  19. HBX System Update Dennis Glorioso Program Management Office Maryland Health Benefit Exchange

  20. System Update Today 20 20

  21. HBX User Acceptance Testing Dennis Glorioso Program Management Office Maryland Health Benefit Exchange

  22. Carrier Testing Agenda • Validate Rates • Plan Shopping • EDI Testing • Timeline

  23. Glossary • SIT – System Integration Testing • UAT – User Acceptance Testing • EDI – Electronic Data Interchange • Release 1 – Plan Management • Release 2 – Eligibility & Enrollment

  24. Validate Rates • Carriers want to ensure rates submitted and approved by MIA are correctly loaded into the system • Four cycles to validate rates

  25. Validate Rates – Initial Preview Testing • August 18 – August 22 • Utilizes the last templates submitted • Deloitte will send screenshots to carriers from the SIT environment: • Templates have been previously loaded • Screenshots from plan shopping • Specific to each carrier • Provide premium rates per plan by rating area • APTC amounts will be set to zero in order for the plan rates to be consistent across the income levels

  26. Validate Rates – Initial Preview Testing (cont.) *Harford, Charles, Montgomery, & Frederick counties

  27. Validate Rates – Release 1 UAT • August 8 – September 8 • August 8 – August 22: MHBE PMO will perform UAT on Release 1 with test plan data previously submitted. • August 25: MHBE PPM will perform UAT on Release 1 with MIA-certified SERFF plan templates. • Once the plan data is uploaded, an Excel extract will be downloaded and sent to Carriers for review on August 27. • Carriers to provide feedback by September 4. • Will provide Excel extract template beforehand.

  28. Validate Rates – Release 2 EDI SIT • August 14 – September 19 • If the templates submitted to Deloitte are the same plans approved by MIA, EDI testing can be used to validate rates • Carriers are expected to load these files and validate the data as done in Production • Scenarios will be shared later in the presentation

  29. Validate Rates – Release 2 UAT • September 22 – October 17 • All defects, enhancements, changes, etc. will follow MHBE’s defect management process. • Since Release 1 goes live on 10/1, any changes identified during this phase will require updates to Production. • May require resubmission of templates to MIA. • 4-hour training session will be arranged for carriers in September.

  30. Validate Rates – Release 2 UAT (cont.) • September 22 – October 3: unstructured carrier UAT testing • Offsite carrier personnel with access to the system. • Carriers can run multiple anonymous browsing scenarios to validate rates in real time. • If any defects are identified during the unstructured testing, carriers are required to submit screenshots of the steps to MHBE by October 6. • October 13 – October 17: structured carrier UAT testing • We will request three representatives from each carrier for onsite testing. • Carrier representatives will be provided with predefined test scenarios/scripts. • October 13 is last day for carriers to submit changes onsite.

  31. Plan Shopping • Ensure plans are displayed correctly with respect to regulatory, marketing, consumer requirements, etc. • Two cycles to validate plan shopping • View CT Health • Plan shopping will be almost identical • Use it as a benchmark to see how plans will be displayed • www.accesshealthct.com • Deloitte to send screenshots to carriers from the SIT environment • Release 2 UAT :: September 22 – October 17

  32. EDI Testing • Ensure EDI systems are correctly passing data. • Data entered in the application is transmitted as expected to the carriers. • Release 2 EDI SIT :: August 14 – September 19 • August 14 :: Initial connectivity testing (ensure files are dropped and picked up successfully) • August 18 – August 27 :: Initial add & effectuation • August 28 – September 19 :: Change/cancel after effectuation • Release 2 UAT :: September 22 – October 17 • Viewed as final validation

  33. EDI Testing - Scenarios

  34. EDI Testing - Scenarios

  35. EDI Testing - Scenarios

  36. EDI Testing - Scenarios

  37. Testing Timeline – August 2014

  38. Testing Timeline – September 2014

  39. Testing Timeline – October 2014

  40. PUBLIC COMMENTS? NEXT MEETING: August 21, 2014 2:00 – 4:00PM UMBC Tech Center

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