Transcript Document

2013
Legislative Preview
Sponsored by:
Presenting
Sponsor
Media Sponsor
#MDNPLP2013
MARYLAND HEALTH
BENEFIT EXCHANGE
Tequila Terry
Director of Plan and Partner Management
#MDNPLP2013
Maryland Nonprofits
Legislative Preview Meeting
January 7, 2013
A service of Maryland Health Benefit Exchange
Topics
What is a Health Insurance Exchange?
The Maryland Health Connection
Establishment Legislation
Implementation Update
Ways to Get More Information
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What is a Health Insurance Exchange?
The Patient Protection and Affordable Care Act
requires each state to establish a “health insurance
exchange” by 2014.
Maryland is creating its exchange to be an
accessible and competitive marketplace for
Marylanders to search for and enroll in affordable
health insurance plans as well as determine
eligibility for Medicaid and federal tax credits.
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What is the Maryland Health Connection?
The Maryland Health Connection is the new name
for Maryland’s health insurance exchange.
The Maryland Health Connection is a marketplace
where individuals, families and small businesses can:
– Compare health insurance options
– Calculate total out-of-pocket costs based on eligible
subsidies or tax credits
– Enroll in the health plan that’s best suited for their
needs
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Individuals & Families
The Maryland Health Connection offers tax credits and cost
sharing subsidies to individuals and families who do not have
access to affordable healthcare insurance
– Federal government will pay a portion of costs for health
insurance for people who earn up to 400% of FPL
– Cost sharing subsidies are available to individuals under 250%
of FPL
Open Enrollment Period Begins: Oct. 2013
Coverage Effective: Jan. 2014
Small Businesses
The Maryland Health Connection will have a Small
Business Health Options Program (SHOP) dedicated
portal for small businesses and their employees
Small businesses (including non-profits) with up to 50
employees may participate
In 2016, employers with up to 100 employees will be
able to participate
Open Enrollment Period Begins: Oct. 2013
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Small Businesses
SHOP Highlights
Tax Credits for Health Insurance will only be
available through Maryland Health Connection
beginning October 1, 2013 as part of the ACA
The SHOP will provide employers:
– Innovative plan options that are easy to administer
– Access to tax credits to cover employee premiums
– Ability to work with TPAs, brokers and agents as
they do today
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Establishment Legislation
Health Care Reform Coordinating Council
– Created in 2010 to advise State government on the
implementation of federal health care reform
• Expand quality and affordable health care
• Reduce waste and control costs
Health Benefit Exchange Act of 2011
– April 12, 2011: Governor O’Malley signed the Maryland
Health Benefit Exchange Act to establish Maryland’s
exchange as a public corporate and independent unit of state
government
– June 3, 2011: Exchange Board held its first meeting
– September 2011: Exchange appointed Executive Director
Stakeholder Engagement
Policy decisions were made through an open, transparent process
with over 60 stakeholders from across Maryland (Fall 2011)
Four Advisory Committees studied six topics:
– Navigator and Consumer Assistance / Advertising
– Market Rules and Risk Selection / Operating Model
– SHOP Exchange
– Financing the Exchange
Executive Director and Board Liaisons attended all 22 meetings
Stakeholder representation included: health insurance industry,
providers and associations, community members, advocates,
community-based organizations, academia, business owners
and leaders, local government officials, consumers, consultants
Health Benefit Exchange Act of 2012
Options laid out in the stakeholder advisory committee
process fed the recommendations from the Exchange
Board to the General Assembly
These recommendations fed the 2012 Exchange bill
Senate Bill 238 and House Bill 443: Maryland General
Assembly recently passed (April 5, 2012) legislation
that outlines the implementation policies and
procedures for operating the exchange
Implementation Update
Level Two Establishment Grant
Maryland was one of four states to receive a Level Two
Establishment Grant on Thursday, August 23, 20121
– Total amount of award: $123 million
Funds will be used to support key implementation activities
– Policy Development
– IT Infrastructure Development
– Creation of Operations & Administration Protocols
– Consumer Assistance Programs
– Outreach & Education Program
1Cooperative Agreement to Support Establishment of State-Operated Health Insurance Exchange (93.525)
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Conditional Certification Received
On December 10th, Maryland was among the first
six states in the U.S. to receive conditional
approval from the Centers for Medicare &
Medicaid Services (CMS) to operate a statebased health insurance exchange in 2014.
Conditional certification indicates that Maryland
will be operationally ready for open enrollment
beginning October 2013 and meets the
requirements of the federal government.
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Maryland’s Essential Health Benefits
The ACA requires that all insurance plans sold inside and outside the health
benefit exchanges in the individual and small group markets cover “essential
health benefits” (EHB)
EHBs must include items/services in the following categories:
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Ambulatory services
Emergency services
Hospitalization
Maternity and newborn care
Mental health and substance use disorder services
Prescription drugs
Rehabilitative and habilitative services and devices,
Laboratory services
Preventative and wellness services and chronic disease management
Pediatric services including oral and vision care
The Maryland Health Care Reform Coordinating Council conducted an inclusive,
public stakeholder process to select Maryland’s EHB package.
Technology
High-Level Technology Milestones
– Phase 1A Vendor Award – March 2012
– Development Kick-Off – May 2012
– Federal Requirement Testing – November 2012
– State Requirement Development & Testing – 1st QTR 2013
– Integrated end-to-end Testing (Includes External
Stakeholders) – 2nd QTR 2013
– Production Environment Live – 2nd QTR 2013
– Open enrollment – 10/1/2013
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Consumer Assistance
Consolidated Service Center
– Streamlined application, customer service through statewide Call Center
Navigators
– Conduct public education and outreach as required by the Affordable
Care Act
– Distribute fair and impartial information
– Facilitate enrollment in health plans
– Provide referrals for grievances, complaints and questions
– Provide information in a culturally and linguistically appropriate manner
– Maintain expertise in eligibility, enrollment and program specifications
– Refer INSURED SMALL GROUPS back to producers
Producers
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Serve an important role in the Exchange
Continue to work directly with small group customers
Register to become authorized to sell QHP inside the Exchange
Be compensated directly by the carriers (as they currently are)
Receive training from the Exchange
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What’s Next?
Continued Development of IT System
Outreach & Education: Q2 2013
Open Enrollment: October 2013
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Looking Ahead
Next Steps
Visit www.MarylandHBE.com
Speak with a CPA about tax credits
Visit www. smallbusinesstaxcredits.org for more
information
Speak with your insurance broker about the changes
underway to find out what health insurance options will
best meet the needs of your employees
Visit the IRS website for more information
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Thank you!
For questions on the information contained in this presentation,
please contact:
Tequila Terry
Director, Plan & Partner Management
Maryland Health Benefit Exchange
Phone: 410.358.5618
Email: [email protected]
www.MarylandHBE.com
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