1. Are We Ready? Outreach and Enrollment Efforts and the Nevada Health Link Great Basin Primary Care Association Annual Meeting September 10, 2013

2. Presentation Overview  Insurance Exchange Design  Goals of the Nevada’s Exchange  Nevada Health Link’s On-line Portal  Implementation Status  Branding and Marketing  Outreach and Enrollment  Qualified Health Plans

3. Insurance Exchange Designs

5. Goals of the Exchange  Increase the number of insured persons in Nevada  Facilitate the purchase and sale of health insurance  Assist qualified employers in the enrollment and purchase of health coverage and the application for subsidies for enrollees  Provide consumer education on matters relating to enrollment in and effective use of health insurance  Assist residents of Nevada with access to programs, premium assistance tax credits and cost-sharing reductions

11. Development and Implementation of Nevada Health Link  IT Implementation is on-time: Eligibility Engine (DWSS/Deloitte) and Business Operations Solution (Exchange/Xerox) will meet the October 1, 2013 deadline for operability  Marketing and Outreach efforts have begun with a media campaign launched July 1, 2013  Coordination efforts between the Exchange and Division of Insurance continue to provide a safe and seamless transition for Nevada’s citizens

12. Marketing/Branding/Outreach  $5,419,900 budget for 15 months  Contract began January 2013  Goal: Enroll 118,000 persons, mainly in 138% to 400% of FPL  Reach hundreds of thousands of Nevadans directly with outreach

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14. Overview of Marketing/Outreach

15. Purchased Media  Link 1 Link 1  Link 2 Link 2  Link 3 Link 3  Statewide media mix by medium:  Television – 42%  Digital – 16%  Radio – 14%  Out-of-Home – 19%  Print – 9%  70% English, 30% Spanish  72% Clark County, 28% Northern Nevada and rural

16. Outreach and Educations Plan for Navigators, Enrollment Assisters and Producers  44% of enrollees will use Exchange Enrollment Facilitators Certified by the DOI – AB425 Navigators - $370,000, ~ 34 individuals in FY 2014 Enrollment Assisters - $1,826,000, ~ 169 individuals, FY 2014 Certified Application Counselors – not paid by Exchange  22% of enrollees will use Brokers and Agents Paid by carriers  30% of enrollees will use Web Portal with the help of a Call Center 50 plus individuals in Las Vegas (staff size flexes with demand)  4% of enrollees will use Web Portal alone

17. Exchange Enrollment Facilitators Navigator and Enrollment Assister organizations:  Inter-Tribal Council of Nevada - Statewide  Know Your Care (Ramirez Group) -Statewide  Great Basin Primary Care Association – Northern Nevada  Consumer Assistance and Resource Enterprise (CARE) – Southern Nevada  East Valley Family Services – Southern Nevada  Latin Chamber of Commerce Community Foundation –Southern Nevada  Richard Allen Community Outreach (RACO) –Southern Nevada

18. Great Basin Primary Care Association Approach to O/E  Partner with organizations already caring for the uninsured in six counties  Six Partner organizations with 16 sites: Community Health Alliance (5 FQHC sites) Northern Nevada HOPES (Ryan White) Pershing General Hospital (RHC) Battle Mountain General Hospital (RHC) Friends In Service Helping (FISH) South Lyon Medical Center (3 RHCs)  Two Navigators, Seven Enrollment Assisters, 14 Certified Application Counselors

19. EEF Discussion Forum (Discussion.NNVEEF.org)

20. Qualified Health Plans (QHPs) The following carriers will offer plans on Nevada Health Link:  Anthem  Health Plan of Nevada  Nevada Health CO-OP  Saint Mary's Approved Rates for plans submitted in the individual and small group markets are available to view on the Nevada Division of Insurance Website.Nevada Division of Insurance Website.

21. Transitional QHPs minimize adverse impacts and improve continuity of care  Medicaid MCOs must provide one silver-level QHP to coordinate the transition for individuals and families whose have a change in Medicaid or CHIP eligibility status.  Individuals enrolled in a Medicaid MCO plan who lose eligibility will proceed through the application like all other applicants. The system will identify that they were recently on a Medicaid MCO plan, and automatically sort the MCO Transition Plan to the top of the plan choices.  A release of information allows coordination of care between the plans  Individuals not transitioning from a Medicaid MCO will be able to purchase coverage on a MCO Transition Plan

22. Essential Community Providers  The Affordable Care Act does not include a requirement that Qualified Health Plans (QHP) contract with FQHCs/RHCs. The law does include a requirement that QHPs contract with “essential community providers” and assure reasonable access to these providers. The definition of ECPs includes those covered entities under the 340B drug discount program.  A QHP must pay an FQHC no less than it would be paid under Medicaid unless the plan and the FQHC agree on a different payment amount (which could not be less than the generally applicable payment rates of the QHP issuer).  A QHP need not contract with an FQHC, but it would have to pay the FQHC based on PPS when the QHP enrollee has gone out-of-plan to the FQHC.

23. Network Adequacy Standards  Because insurance carriers were required to submit their plans for certification as QHPs in June of this year, the Health Exchange had to adopt network adequacy standards for QHPs for the 2014 plan year.  Legislation was passed in 2013 to move responsibility for monitoring network adequacy from the SSHIX and the Health Division to the Division of Insurance starting in the 2015 plan year. The bill also expands network adequacy standards so that they apply to the entire health insurance market.  The state’s standard does not explicitly include the full safe harbor standard, specifically, the requirement to contract with one ECP type per county  Many states have implemented standards that include“any willing ECP”  Time and distance standards were used that exceed those of Medicaid and the Bureau Of Primary Health Care

24. Moving Forward  Hire, Hire, Hire, Hire and Train  Implement In-reach and Outreach plans  Enroll, Enroll, Enroll  Advocate for implementation of the full “Safe Harbor” standard  Engage in public workshops to create network adequacy standards for 2015 that enhance consumer access and recognize innovations in care delivery

25. Thank you