A service of Maryland Health Benefit Exchange Maryland Health Benefit Exchange Implementation Advisory Committee Meeting September 4th, 2014

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

A service of Maryland Health Benefit Exchange Renewal Outreach Program Paul Barringer, Optum

MHC & 2015 Coverage Renewals September 4,

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 5 Focused solely on health insurance and healthcare, Optum understands the purpose behind the health insurance exchanges… …Our dedicated public sector organization brings the full set of Optum capabilities to every government customer to help the health system work better for everyone Health Services is What Optum Does

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 6 Optum has a proven track record in successfully supporting and remediating the federal exchange as well as in supporting a number of state health benefit exchanges. In Maryland, Optum/QSSI has assisted with: Enrollments Life events Data analysis and reporting Analytics support Renewals Optum’s Exchange Experience

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 7 Renewing Coverage for 2015: Key Considerations Consumers who bought a health plan through Maryland Health Connection in 2014 must renew coverage for 2015 to continue to receive financial assistance or to determine eligibility for assistance Consumers who would like help with renewing have multiple options for receiving assistance Consumers renewing independently must submit a new application at by December 18, 2014 to ensure that coverage starts Jan. 1, Consumers not successfully completing a new application at will receive a bill as of January 1, 2015 showing the cost of their plan without financial assistance

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 8 Optum’s Role in Supporting Renewals Developing and maintaining a list of individuals with effectuated QHP enrollments; tracking renewals through old and new systems Coordinating with brokers/producers and connector entities to provide updated lists of consumers who elect in-person assistance Coordinating additional outreach (including automated dialing and campaigns) to encourage renewal enrollments Supporting outreach initiatives by MHBE to encourage consumers to re-enroll in a timely basis

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. Renewals Outreach Activities , letter and phone call to invite consumers to participate in tracking program and receive free in-person assistance completing their renewals application Social media campaign Paid media campaign MarylandHealthConnection.gov webpage will have detailed information on the renewals processMarylandHealthConnection.gov Multiple Notices sent by MHBE throughout open enrollment and post enrollment 9

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. Call to Action Schedule Call to Action 1: MHBE: Oct 1 st - Inform consumers of renewals process - Provide opportunities for in- person assistance to renew Call to Action 2: Carriers: Nov 10-15th - Description of redetermination and renewal process - APTC and CSR received in Deadline reminder for 1/1 coverage Call to Action 3: Carriers: Dec 1st - Explanation of the automatic renewal process - Explanation of tax reconciliation - Option to purchase coverage w/o financial assistance directly through the carrier 10

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. Call to Action 1 (Oct. 1 st ) from MHBE MHBE will send a description of the annual redetermination and renewal process which addresses the following: Individuals will need to have an eligibility redetermination – through the website, navigator, producer or call center – to be considered for financial assistance in Those who do not have an eligibility redetermination and select a plan through the website will be automatically renewed into an exchange plan without APTC or CSR. Individuals will have the option to see all health plans through the new website, and may enroll in the same plan they had for 2014 or choose a different one. Individuals will have the ability to get assistance through producers, navigators and others for renewal through the website – and how to access such assistance. A description of the reconciliation process at tax time. The requirement to report changes to information affecting eligibility and the timeframe and channels through which changes can be reported. The option to purchase coverage without any financial assistance by going directly to a carrier. 11

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. Call to Action 2 (before Nov 15 th ) from Carriers Carriers will send a description of the annual financial assistance eligibility redetermination and renewal process which addresses the following: Individuals will need to have an eligibility redetermination through the website, navigator, or call center, to be considered for financial assistance in Those who do not have an eligibility redetermination and select a plan through the website will be automatically renewed into an exchange plan without APTC or CSR. A reminder of their APTC and CSR received in The option to see all health plans through the new website. The ability to get assistance through producers, navigators and others for renewal through the website, and explanation on how to access such assistance. A description of the reconciliation process at tax time. The requirement to report changes to information affecting eligibility and the timeframe and channels through which changes can be reported. The option to purchase coverage without any financial assistance by going directly to carriers. If they take no action to get a eligibility redetermination, they will be automatically renewed without financial assistance, including: dates of renewal period, health benefit plan rates, terms of coverage, the deadline to avoid automatic renewal. 12

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. Call to Action 3 (~ December 1 st ) from Carriers Carriers will send a notice about the default of automatic renewal, with the premium and payment deadline. We will have a session with MIA to identify ways to provide this information without confusing consumers from the core message of encouraging redetermination. 13

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. Notice Coordination MHBE and insurance carriers share the responsibility to send notices and conduct sufficient outreach to consumers Consistency in message content Alignment in message timing Maximize communication to consumers Multiple perspectives on reasons to renew Opportunities to reduce redundancy and sync notices Ensure that all legal requirements are met 14

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. Renewing after Open Enrollment After open enrollment, and on an ongoing basis, Optum will provide carriers with a list of individuals who have not renewed in the new system. Carriers will renew these individuals in on-exchange plans without APTC and CSR. Optum will continue to track individuals who did not renew in the new system through open enrollment. 15

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. MHBE and Carrier Outreach and Coordination Outreach Efforts to Encourage Consumers to Renew Consumer renews enrollment through the new system Consumer does not renew enrollment through the new system Optum provides list of individuals to carriers who did not renew through the new system Carriers renew individuals in on- exchange plans without APTC or CSR for 1/1 coverage Post 12/18, consumers renew through the new system Effectuate in carrier- renewed plan Cancelled due to non- payment in carrier- renewed plan 16

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. Questions / Comments?

A service of Maryland Health Benefit Exchange Renewal Timeline Michele Eberle, Plan Management

A service of Maryland Health Benefit Exchange CRISP Presentation Jeremy Wong, CRISP

CRISP Provider Search: Open Enrollment and Error Correction Update September 4, 2014

Current State and Open Enrollment

22 CRISP Provider Search Website – Search by Provider

23 CRISP Provider Search Website – Provider Profile

24 Current State – Site Usage Site Stats 65,000 visits since 10/1/ visits per day during Open Enrollment Last week of March: 700 visits per day March 31, 2014: 1,674 visits December 31, 2014: 1,000 visits

25 Connecticut Migration The Connecticut system has no integrated provider data Consumers are linked to the carriers’ provider directory Maryland consumers will be linked to the CRISP Provider Search site For Open Enrollment 2014, the CRISP Provider Search site will be the sole way to access provider data

Provider Error Corrections Current State – Data Flow QHPsMCOs Optum (P360 Data Scrubbing) CRISP CRISP Provider Search Maryland Health Connection Data Submission Provider Data Processing Consumer Sites

27 Currently, CRISP relies on carriers to make error corrections Current Provider Error Correction Process 1.Providers report errors to CRISP 2.CRISP determines which carrier(s) submitted the error 3.Each month, CRISP submits a Provider Error Report to each carrier 4.Carriers follow-up with providers to resolve errors 5.Carriers correct errors in subsequent bi- weekly submissions to CRISP

Provider Error Corrections Open Enrollment – Data Flow QHPsMCOs Optum (P360 Data Scrubbing) CRISP CRISP Provider Search Data Submission Provider Data Processing Consumer Sites

Error Correction Initiative 29

30 CRISP has received various feedback detailing inaccuracies in provider data Provider errors can be divided into two categories: Demographics errors involve providers’ addresses, phone numbers, and office hours Network errors involve specialty and disputed inclusion in a carrier’s network

CRISP is currently conducting an Error Correction Pilot Unified portal where providers can view carrier-submitted information and submit updates Demographics corrections (addresses, locations, and office hours) can be made immediately Network corrections would be submitted to the appropriate carrier(s) CRISP is developing provider identity proofing The Error Correction functionality is on-target to be live by late Error Correction Pilot

32 CRISP will develop appropriate “trust levels” with Optum to ensure corrections made align with MHBE business goals Develop “trust levels” with Optum to determine which provider information is displayed Optum will trust CRISP data (over carrier data) for approved demographics fields and make real-time corrections Optum will trust MCOs and QHPs for network corrections

Automated Carrier Error Reports 33

34 CRISP is developing methodology for sending automated Error Reports to carriers Proposed File Requirements Distinguish between Demographics and Network Corrections Carriers should update provider information based on Demographics Changes Carriers should adjudicate Network Changes with carrier and make changes in subsequent CRISP Input Files Identify if information should be added or removed for a provider The text file will be delivered to a SFTP location every day for which there is an error correction submitted to CRISP for that carrier.

35 CRISP recommends a pipe-delimited flat file Proposed File Format 1. CRISP proposes a pipe-delimited text file. 2. The file will include identifying information about the provider (e.g., first name, last name, and NPI) 3. Corrections will be tagged as either as “Demographics” or “Network.” 4. Corrections will be tagged with “add” or “remove” – followed by the relevant piece of information. Demographics|Remove|Address|1 Main St.||Columbia|MD|21046| Network|Add|Specialty|Cardiology Network|Remove|All CareFirst plans

Next Steps 36

37 Next Steps 1.CRISP will distribute a final Error Correction File Format and Delivery document 2.Carriers can respond with questions or suggestions 3.When development is complete, CRISP will invite carriers to test functionality and provide feedback

A service of Maryland Health Benefit Exchange HIX Update Nabila Rahman, Optum

A service of Maryland Health Benefit Exchange MHBE IAC System Update September 4, 2014

Glossary SIT – System Integration Testing UAT – User Acceptance Testing EDI – Electronic Data Interchange Release 1 – Plan Management Release 2 – Eligibility & Enrollment 40

Agenda System Implementation Timeline Release 1 UAT Release 2 SIT & UAT Meetings 41

System Implementation Update - Timeline 42 UAT Today

Release 1 UAT Last week, carriers should have received –Rate data extract –Benefit data extract Benefit data extract contains multiple errors –New file will be ed by COB Friday, September 5 –Submit feedback by COB Wednesday, September 10 Continue validating rate data –Submit feedback by COB Friday, September 5 –Received feedback that the rate extract is rounding incorrectly. Continue to validate and let us know if you see this issue. Submit Individual SBCs by September 10 43

Release 2 SIT –Received feedback from the ed screenshots of plan shopping experience from SIT environment. Investigating your feedback. –Ongoing EDI 834 testing – please reach out if you have concerns UAT –Thank you for submitting names for onsite testing. –September 15 – September 19: individual meetings with each carrier to walk through portal –September 22 – October 3: unstructured carrier UAT testing Access to anonymous browsing Ability to confirm rates and plan display –October 13 – October 17: structured carrier UAT testing Full access to end-to-end system – hitting the FDSH, identity proofing, generating 834s, etc. Utilize MHBE-defined scripts 44

Meetings Daily EDI 834 testing calls (short term) Weekly Plan Management and Operational calls 45

A service of Maryland Health Benefit Exchange SHOP Update Stephanie Lee, MHBE Plan Management

A service of Maryland Health Benefit Exchange Dental Updates Michele Eberle, MHBE Plan Management

Renewal of 2014 SADP’s Tax subsidies have been rarely applied to dental policies per the National Association of Dental Plans (NADP) Dental benefits maintain a HIPAA-excepted benefit status Dental benefits are exempt from guaranteed renewability Renewal notices are not applicable to SADP’s, but NADP has encouraged members to use them The FFM is including SADPs in their auto-renewal process Md. Insurance Code Ann (a) (4) includes the renewal requirements for carriers and defines carriers as including dental plans About 7000 consumers purchased SADP’s through MHC in 2014, mostly family dental plans CMS is borrowing the uniform modification of coverage test for the purposes of recertification of SADP’s [CMS FAQ 2639, 7/3/14]

Renewal of 2014 SADP’s If a consumer wishes to reenroll and maintain their QHP but change their SADP, how will the consumer be instructed to do so? If a consumer wishes to maintain their SADP but change their QHP, how will the consumer be instructed to do so? How will reenrollments occur if a consumer does not come back through the MHC website for reenrollment? Will coverage end? Will dental carriers need to automatically re- enroll in the same plan? What reporting requirements will MHBE have of dental carriers for renewing members? Are dental carriers to planning to send notices to members regarding reenrollment? Items being addresses

A service of Maryland Health Benefit Exchange 2015 Dental Plan Display Michele Eberle, MHBE Plan Management

NEXT MEETING: September 18th, :00 – 4:00PM UMBC Tech Center PUBLIC COMMENTS? 51