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Health Insurance Exchange Workgroup August 29, 2012

Health Insurance Exchange Workgroup August 29, 2012. Presented by: Tom Donovan, Deputy Director, Insurance Valerie Fend-Boehm, Project Staff. Agenda. Subcommittee Support CCIIO Blueprint Review CCIIO Guidance Review. Subcommittee Support. Introduction Support Research & resource support

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Health Insurance Exchange Workgroup August 29, 2012

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  1. Health Insurance ExchangeWorkgroupAugust 29, 2012 Presented by: Tom Donovan, Deputy Director, Insurance Valerie Fend-Boehm, Project Staff Health Insurance Exchange Work Group

  2. Agenda Subcommittee Support CCIIO Blueprint Review CCIIO Guidance Review Health Insurance Exchange Work Group

  3. Subcommittee Support • Introduction • Support • Research & resource support • Attend sub-committee meetings • Assist with other needs/requests • Weekly Resource List • Evolving Tool • For you! Health Insurance Exchange Work Group

  4. Overview of Blueprint for Approval of Affordable State-based and State Partnership Insurance Exchanges Health Insurance Exchange Work Group

  5. Blueprint Review • What? • Identifies options for State flexibility in the development of Exchanges. • Outlines specific requirements to apply for approval as a State Based Exchange or Federally-facilitated Partnership Exchange. Health Insurance Exchange Work Group

  6. Blueprint Review Flexible Exchange Options for States Health Insurance Exchange Work Group

  7. Blueprint Review Exchange Approval Timeline for Plan Year 2014 Health Insurance Exchange Work Group

  8. Blueprint Review Transition Timeline Health Insurance Exchange Work Group

  9. Blueprint Review Blueprint Approval Health Insurance Exchange Work Group

  10. Blueprint Review • Declaration Letter: • Part I of Application • Required for SBE, FFE-P, and FFE (with reinsurance) States; encouraged for FFE. Health Insurance Exchange Work Group

  11. Blueprint Review • Assumptions in the Absence of an Declaration Letter • The State will not administer it own reinsurance program; • “The State’s small group and individual markets will be merged in the Federally-facilitated exchange only if the current individual and small-group markets are merged. Is a State does not merge the individual and small-group-market risk pools, the SHOP will permit each qualified employee to enroll only in QHPs in the small-group market; and • The State’s current definition of “small-group” employer (e.g. “up to 50” or “up to 100” employees) will be followed, while the method of determining employer size will be based on full-time equivalent employees consistent with other Affordable Care Act policies.” Health Insurance Exchange Work Group

  12. Blueprint Review • Application Health Insurance Exchange Work Group

  13. Blueprint Review • Exchange Blueprint submission includes: • Attestations of completion of Exchange Activities or the dates of expected completion • Supporting documentation, including descriptions of processes and strategies • Attachment of reference files and Testing Files, including results of State testing, HHS-developed test scenario testing, and Independent Verification and Validation (IV&V) testing Health Insurance Exchange Work Group

  14. Blueprint Review • Application Health Insurance Exchange Work Group

  15. Blueprint Review Health Insurance Exchange Work Group

  16. Blueprint Review • More Information? • CCIIO Blueprint ‘Deep-Dive’ Webinars • Questions? Health Insurance Exchange Work Group

  17. Overview of General Guidance on Federally-facilitated Exchanges Health Insurance Exchange Work Group

  18. Guidance Review • What? • Outlines HHS’s approach to implementing an FFE in a state without a SBE, including: • How States can partner with HHS to implement selected functions in a FFE (Partnership) • Key policies organized by Exchange function, and • How HHS will consult with a variety of stakeholder to implement an FFE. Health Insurance Exchange Work Group

  19. Guidance Review • Section I: Background • Section II: State Partnership in an FFE Health Insurance Exchange Work Group

  20. Guidance Review • Section III: Approach to Key Exchange Functions in a Federally-facilitated Exchange • Plan Management (pg. 8) • Accreditation and Quality Reporting (pg. 11) • Eligibility and Enrollment (pg. 12) • Consumer Support & Outreach (pg. 15) • Federally Facilitated-SHOP (pg. 16) Health Insurance Exchange Work Group

  21. Guidance Review • Section IV: Stakeholder Input • “HHS will work closely with local stakeholders to implement each FFE, including in State where a Partnership is operating. HHS is committed to creating a transparent process for FFE development in each State, and will seek input from stakeholders and provide technical assistance to those stakeholders working with an FFE.” Health Insurance Exchange Work Group

  22. Guidance Review • Questions Health Insurance Exchange Work Group

  23. Thank you Health Insurance Exchange Work Group

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