Department of Health Care Policy and Financing COLORADO HEALTH REFORM IMPLEMENTATION October 2012

Department of Health Care Policy and Financing HEALTH IN COLORADO Improve health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources.

Department of Health Care Policy and Financing INSURANCE REFORMS Insurance Accountability Dependent care coverage for adult children to age 26 No pre-existing conditions exclusions for children No lifetime limits No rescissions Medical Loss Ratio to 80% ind. market and 85% large group market (2010 reporting, 2011 rebates) Free preventive care (new plans) Begin phase out of annual limits No annual limits Guaranteed issue Guaranteed renewability No gender rating No health status rating Age rating 3:1; Geographic variation/tobacco rating 1.5:1 Improve health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources.

Department of Health Care Policy and Financing COVERAGE Coverage Improve health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources.

Department of Health Care Policy and Financing Improve health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources. 3 MEDICAID AND SUPREME COURT

Department of Health Care Policy and Financing WHAT IS A HEALTH BENEFIT EXCHANGE? Improve health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources.

Department of Health Care Policy and Financing

Passed in May 2011 SB200 establishes the framework for the state Exchange Not to duplicate the functions of the DOI Governed by a Board of Directors Legislative Implementation Review Committee Mission is to increase access, affordability, and choice for individuals and small employers purchasing health insurance in Colorado. SB11-200: CO HEALTH BENEFIT EXCHANGE ACT OF 2011 Improve health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources.

Department of Health Care Policy and Financing BENDING THE COST CURVE Cost Containment Improve health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources.

Department of Health Care Policy and Financing Improve health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources. Accountable Care Collaborative Statewide Data and Analytics Contractor SDAC Gives client utilization data and program performance data to PCMPs and RCCOs Regional Care Collaborative Organizations Build provider network; support PCMPs with practice support & care coordination Primary Care Medical Providers PCMPs Medical homes for clients 8

Department of Health Care Policy and Financing Improve health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources. Room for Experimentation: HB 1281 Courtesy: Colorado Health Institute

Department of Health Care Policy and Financing Improve health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources. Long Term Services and Support

Department of Health Care Policy and Financing Improve health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources. FOCUS ON BUSINESS

Department of Health Care Policy and Financing Improve health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources. EMPLOYER FLOW CHART

QUESTIONS & ANSWERS Sue Birch Executive Director Health Care Policy and Financing colorado.gov/healthreform