EXAMINING THE NUTS AND BOLTS OF INDIANA’S EXCHANGE March 15, 2013 Sarabeth Zemel National Academy for State Health Policy.

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Presentation transcript:

EXAMINING THE NUTS AND BOLTS OF INDIANA’S EXCHANGE March 15, 2013 Sarabeth Zemel National Academy for State Health Policy

What is State Refor(u)m? Online peer-to-peer learning and discussion A library to post, and share, and organize useful state resources Real-time analysis of states’ progress in implementing health reform NASHP and State Refor(u)m implementation What is NASHP? Independent academy of state health policymakers working together to identify emerging issues, develop policy solutions, and improve state health policy and practice. A forum for constructive work across branches and agencies of state government on critical health issues facing states.

-states-stand-on-exchanges State Action on Exchanges

What’s a State’s Role in an FFE? Regulating Insurance? Educating Consumers? Referring to Federal Exchange?

Key Deadlines for FFE Benchmark plan decision or default due December 26, 2012: Federal navigator grants awarded June 2013 QHPs begin submitting applications to federal exchange for 2014 April 2013: CCIIO reviews QHP applications May-June 2013: CMS notifies issuers of QHP certification decisions for FFE September 2013: Open enrollment on exchange begins October 1, 2013: Coverage begins January 1, 2014

Exchange Plan Certification: General/Federal Requirements Prohibition on Discrimination Appropriate Actuarial Values/ Metal Levels Network Adequacy Compliance with Marketing Requirements Accredited by Recognized Entity

Licensure and solvency No preexisting condition exclusions No lifetime limits Limited annual limits Prohibitions on recissions No cost-sharing on preventive care Dependent coverage requirements Internal and external appeals process Enhanced access to primary care, pediatricians, ER, Obgyn MLR 85% large group 80% small group and refunds Risk adjustment, single risk pools within markets Guaranteed access and renewability of coverage Rate review and uniform rating Uniform explanation of coverage All states have to do these or the feds will A heavy lift for states Without these consumer protections, harder to get insurance and get payment for services Insurance Market Reforms

2014 Market Reforms Accessibility Guaranteed Issue Waiting periods Affordability Rating requirements Adequacy Preexisting condition exclusions Essential health benefits OOP costs Actuarial value

Risk Adjustment and Reinsurance ProgramAdministered byTime PeriodMarkets impacted (excludes grandfathered plans) Risk adjustmentHHS or statesPermanentIndividual and small group- inside and outside exchanges ReinsuranceHHS or states3 yearsIndividual- inside and out of exchanges Risk corridorsHHS3 yearsIndividual and small group in exchange

Resources State Refor(u)m: CMS National Health Insurance Marketplace Stakeholder call Date: Monday, March 18, 2013 Time: 2-3 pm EDT Register: