Health Insurance Exchange Workgroup August 29, 2012 Presented by: Tom Donovan, Deputy Director, Insurance Valerie Fend-Boehm, Project Staff 18/29/2012Health Insurance Exchange Work Group

Agenda 1. Subcommittee Support 2. CCIIO Blueprint Review 3. CCIIO Guidance Review 28/29/2012Health Insurance Exchange Work Group

Subcommittee Support Introduction Support ◦ Research & resource support ◦ Attend sub-committee meetings ◦ Assist with other needs/requests Weekly Resource List ◦ Evolving Tool ◦ For you! 8/29/2012Health Insurance Exchange Work Group3

Overview of Blueprint for Approval of Affordable State- based and State Partnership Insurance Exchanges 8/29/2012Health Insurance Exchange Work Group4

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. 8/29/2012Health Insurance Exchange Work Group5

Blueprint Review 8/29/2012Health Insurance Exchange Work Group6 Flexible Exchange Options for States

Blueprint Review Exchange Approval Timeline for Plan Year /29/2012Health Insurance Exchange Work Group7

Blueprint Review Transition Timeline 8/29/2012Health Insurance Exchange Work Group8 Plan Year Blueprint DueOperationalCoverage Begins 2014November 16, 2012October 01, 2013January 01, November 18, 2013October 01, 2014January 01, November 18, 2014October 01, 2015January 01, 2016

Blueprint Review Blueprint Approval 8/29/2012Health Insurance Exchange Work Group9 Full ApprovalConditional Approval Meet all approval requirements on January 1, 2013 Do not meet all requirements, but are making “significant progress” Completed all Exchange activities, supporting documentation & operational readiness evaluation Defined milestone & dates for operational readiness reviews Exchange operational by 10/01/2013

Blueprint Review Declaration Letter: ◦ Part I of Application ◦ Required for SBE, FFE-P, and FFE (with reinsurance) States; encouraged for FFE. 8/29/2012Health Insurance Exchange Work Group10

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.” 8/29/2012Health Insurance Exchange Work Group11

Blueprint Review Application 8/2/2012Health Insurance Exchange Work Group12

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 8/2/2012Health Insurance Exchange Work Group13

Blueprint Review Application 8/29/2012Health Insurance Exchange Work Group14

Blueprint Review 8/29/2012Health Insurance Exchange Work Group15

Blueprint Review More Information? ◦ CCIIO Blueprint ‘Deep-Dive’ Webinars Questions? 8/29/2012Health Insurance Exchange Work Group16

Overview of General Guidance on Federally-facilitated Exchanges 8/29/2012Health Insurance Exchange Work Group17

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. 8/29/2012Health Insurance Exchange Work Group18

Guidance Review Section I: Background Section II: State Partnership in an FFE 8/29/2012Health Insurance Exchange Work Group19

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) 8/29/2012Health Insurance Exchange Work Group20

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.” 8/29/2012Health Insurance Exchange Work Group21

Guidance Review Questions 8/29/2012Health Insurance Exchange Work Group22

Thank you 8/29/2012Health Insurance Exchange Work Group23