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ACA 2014 & Beyond Rhonda Fossitt Senior Deputy Director.

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Presentation on theme: "ACA 2014 & Beyond Rhonda Fossitt Senior Deputy Director."— Presentation transcript:

1 ACA 2014 & Beyond Rhonda Fossitt Senior Deputy Director

2 ACA: 2014 Michigan Successes 272,539 Michiganders enrolled in Marketplace plans 13 Health Companies Participated in Marketplaces Federal/State partnership protects Michigan companies and consumers

3 ACA: Key Decisions Transitional Policy: Nov Extended Transitional Policy: April 2014 SHOP (Small Business Health Options Program) Employee Choice: June 2014

4 ACA: 2015 Challenges Short timeline to prepare & approve QHP filings Pricing Late guidance Redetermination and renewals

5 2015 Perspective: A Game of Survivor 5 Late Release of Review Tools Late Release of Review Tools Transitional Policy Decisions Employee Choice in SHOP Decision Turn-over of HHS Staff Turn-over of HHS Staff Template Challenges Redetermination and Renewals Redetermination and Renewals Interpreting Late HHS Rules Interpreting Late HHS Rules High Workload Due to Participation High Workload Due to Participation

6 Updates for Health Insurers file for participation on the Marketplace o Increase from 13 Health Insurers in 2014 o Competition fostered by effective & efficient regulatory environment “2015 Marketplace Plan & Rate Information” added to DIFS website to provide: o Rate Change Requests & Public Comments o Dental Information o Map of Rating Areas o SERFF Portal: Health Rates & Forms Filings

7 Deadlines for 2015 QHP Application Submission and Review Process Michigan Filing Deadline06/09/2014 Plan ID Crosswalk Template08/04/2014 DIFS Transfers Plan Data to CMS08/08/2014 CMS Reviews Plan Data08/11/2014 to 08/25/2014 CMS Notifies DIFS of Necessary Corrections to QHP Data 08/26/2014 Final Deadline for Issuers to Resubmit Data Into SERFF 09/04/2014 DIFS Transfers Revisions to CMS09/05/2014 to 09/10/2014 CMS Completes Re-Review of Plan Data and State Recommendations 09/22/2014 Limited Window for Plan Correction09/24/2014 to 10/06/2014 QHPCertification Notices and QHP 10/14/2014 Agreement/FinalAgreements Sent to Issuers, CertificationAgreements Signed, QHP Data FinalizedTo 11/03/2014 Open Enrollment11/15/2014

8 Plan & Benefit Template – Report from D IFS In Year 2 -actuarial value stayed fairly constant -catastrophic plans understood -out-of-pocket max understood Positive Feedback -25% of companies used data integrity tools & review tools -most companies timely provided complete answers in objection responses -Ways to reduce errors & objections -use data integrity & review tools -check Plan & Benefit Template to be sure it matches forms

9 Preview of the Issues: 2016 and Beyond 1/1/2016: Definition of Small Group will increase from 50 to 100 members 1/1/2016: Essential Health Benefits will be redefined - criteria unknown 1/1/2017: State decision on whether we would add large group to the SHOP

10 Resources that DIFS Provides to Health Insurers Bulletins Industry Q & A Sessions -Monthly MAHP Meetings -These questions are added to FAQs on DIFS’ website FAQs on DIFS’ website -Affordable Care Act - 11 Categories SERFF - State Messages Conference Calls

11 What Does HAPPY mean to DIFS Health Plans Staff? A successful transmittal of a Binder through SERFF to HHS The message that comes back indicates “HAPI” We have gone with this theme


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