Washington Health Benefit Exchange Audio: 1-866-244-8528; passcode 474987 Plan Management Meeting November 19, 2013.

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Presentation transcript:

Washington Health Benefit Exchange Audio: ; passcode Plan Management Meeting November 19, 2013

Agenda TopicFacilitatorDuration Welcome  Introductions  Agenda Review/Meeting Purpose Susanne Towill 5 Min Policy/Legislative Update  Updates  Question & Answer Michael Arnis 15 Min Provider Directory  Updates  Question & Answer Dustin Arnette10 Min Monitoring and Compliance  Updates  Question & Answer Dustin Arnette15 Min 2015 Plan Management Preparation  Highlights from 2014  Request for Feedback for 2015 Susanne Towill 30 Min 2015 Guidance for Participation QHP & QDP  Overview  Request for Feedback Zach Snyder 30 Min Next Steps / Close  Next Workgroup Meeting: January 14 th, 2014 Susanne Towill5 Min

Policy/Legislative Update Michael Arnis Associate Policy Director

Provider Directory Dustin Arnette Plan Manager

Provider Directory ▪ Post “go-live” feedback ▪ National Provider Identifier (NPI) ▪ Making this a required data field ▪ Future Enhancements: ▪ Static “inbound” folder ▪ Expanded search radius ▪ Adding clinic name to search and results ▪ Search by issuer ▪ Specialty search ▪ New entrants and transition for

Monitoring and Compliance Dustin Arnette Plan Manager

Monitoring and Compliance ▪ Ensure ongoing compliance with certification criteria after initial certification ▪ Federal regulations applicable to operation of a State-based Marketplace (“SBM”) ▪ Additional details in the Guidance for Participation documents: ▪ Section 2.4 – Monitoring and Compliance of Qualified Health Plans (p. 17) ▪ Section 2.3 – Monitoring and Compliance of Qualified Dental Plans (p. 13) 7

QHP & QDP Compliance and Monitoring Dashboard May 2014 Fictitious data for discussion purposes only

QHP & QDP Compliance and Monitoring Dashboard May 2014 Full Carrier Report (excerpt) Fictitious data for discussion purposes only

QHP & QDP Compliance and Monitoring Dashboard May 2014 Summary of Noncompliance Fictitious data for discussion purposes only

QHP & QDP Compliance and Monitoring Dashboard May 2014 Complaint and Enrollment Metrics Fictitious data for discussion purposes only

2015 Plan Management Preparation Susanne Towill Senior Plan Manager

Reflection on 2014 ▪ Lessons Learned ▪ Communication methods ▪ Benefit data translation ▪ Timeline and flow ▪ Third party QA ▪ Feedback Requested ▪ What worked well for you? ▪ What can be improved for this year? ▪ Other thoughts? ▪ Further feedback can be sent to:

Preparing for 2015 ▪ Communications: ▪ Bi-Monthly Meetings ▪ Alternating Bi-Monthly Newsletter ▪ Plan Management Webpage refreshed ▪ Timeline & Flow ▪ Coordinating drafting with federal and state requirements ▪ Guidance for Participation ▪ Goal to publish drafts in December and final February 1 st. ▪ CMS Data Templates ▪ Providing feedback to CMS

Guidance For Participation Zach Snyder Plan Manager

2013 QHP/QDP Guidance For Participation 17

Needed Revisions ▪ Update Regulations ▪ Plan Management Timeline ▪ Checklist ▪ Suggestions? 18