1. Choose Your Own Adventure: State Exchange Update Scott Leitz NASHP Conference Oct 5, Kansas City, MO

2. Progress Toward Be Strategic with Insurance Exchange *as of Sept. 2011

3. Milestones in Exchange Indicator 1.Decide whether to establish a state, sub-state, or multi-state Exchange or defer to the federal government 2.Solicit stakeholder input on Exchange design 3.Determine policy goals for the Exchange 4.Establish governance of the Exchange 5.Define the health plan selection strategy of the Exchange 6.Develop an implementation plan and timeline for building an Exchange that will be operational on or before January 1, 2014 7.Develop IT infrastructure specifications for the Exchange 8.Develop specifications for a user-friendly Exchange website and a call center for exchange customer service 9.Adopt provider network standards for Exchange plans that meet or exceed those required by federal laws and regulations 10.Adopt a plan rating system that meets or exceeds standards developed by the federal government 11.Develop enrollee billing procedures and allocate responsibilities among the Exchange, employers and qualified plans 12.Determine how health plan benefit design in the Exchange will meet federal standards for essential benefits and tiers 13.Develop a plan for making the Exchange financially self-sustaining by 2015 14.Develop a strategy for educating consumers and employers about their rights and responsibilities regarding the Exchange 15. Test the Exchange's functionality with individual and small employer users 16.Develop financial reporting, audit, internal controls, accounting policies, and other related practices for the Exchange

4. Progress Toward Be Strategic with Insurance Exchange * "Percent progress" has not been derived from a comprehensive survey of state health reform implementation progress. It refers to the number of milestone tasks a state has completed divided by the 16 milestones that are listed within the Exchange indicator. Data as of 9/23/2011

5. What Types of Exchange-Related Documents Are States Sharing? Legislation Executive Orders Board Memos Meeting Minutes Grant proposals RFPs Market Research Workplans and timelines Job Descriptions

6. Who is Sharing Exchange-Related Info? Legislation Executiv Orders Board Memos Meeting Minutes Grant proposals RFPs Market Research Workplans and timelines Job Descriptions

7. Find and Share Information and Ideas See the number of documents, the number of discussions, and the number of states participating in discussions. Synthesis Tools and Blog: www.statereforum.org/bl og “ 18 First Steps Forward for State Exchanges” and “Highlights from Second Round of Exchange Establishment Grants”