federally-facilitated exchange partnership planning in arkansas: where we’ve been; where we are...
TRANSCRIPT
Federally-facilitated Exchange Partnership Planning in Arkansas:
Where We’ve Been; Where We Are Now; and Lessons Learned
Cynthia Crone, APNArkansas Insurance Department
Presented to
Idaho Health Insurance Exchange Working GroupOctober 9, 2012
• Low Per Capita Income
• Poor Health Status Indicators
• Large and Growing Percentage of Uninsured
• Medicaid Deficit Expected in 2013
• Health Agency Leaders Working Together to Improve Health System
Arkansas Landscape
Arkansas Health System Improvements
• Payment and Quality Transformation using Evidence-Based Episodes of Care PCMC Model
• Workforce
• Health Information Technology
• Health Benefits Exchange
ACA and Arkansas Political Landscape
• Popular Governor
• Democrats are Majority in Legislature, Growing Number of Republicans
• Vocal, Active TEA Party Republicans Opposed to ACA and therefore to Exchanges
Exchange Planning
• Arkansas Insurance Department is Lead Agency
• Commissioner is Governor Appointee and “Planning Authority”
• Funding to Date– Exchange Planning – Level One Cooperative Agreements (2)
How Many Will Be Affected?• An estimated 572,000 Arkansans will be eligible for
Exchange coverage beginning January 1, 2014.
• It is conservatively estimated that:− 328,000 more nonelderly Arkansans will enroll (resulting
in a 60% decrease in uninsured post-ACA).− There will be a $615 million reduction in uncompensated
care among nonelderly (a 68% change post ACA).− There will be $478 million in federal subsidies provided
for Arkansans to purchase insurance.
Source: State Progress Toward Health Reform Implementation: Slower Moving States Have Much to Gain, Timely Analysis of Immediate Health Policy Issues, January 2012 Urban Institute analysis, HIPSM
“As Is” (Pre-ACA)(ACHI, 2012)
2014 (Post ACA)(ACHI, 2012)
Development of Partnership Model
•Arkansas did not obtain authority for State Exchange - 2011
•Arkansas did not seek Level One funding - September - 2011
•Partnership Option Announced by CCIIO - September 2011
•Exchange Planning Steering Committee recommended that “planning for a State Exchange end” - November 2011
•Obtained Governor’s approval to explore Partnership Model and apply for Level One Funding - December, 2011
Arkansas is Planning “Full” Partnership Model
• Plan Management
• Consumer Assistance
• Medicaid – FFE Integration
Level One Funding “and Waiting”
• First Level One funding award received February 2012
• Required to obtain Legislative Approval for Spending
• While “waiting”…– Exchange Planning Grant No Cost Extension kept small staff
operating
– Designed Stakeholder Engagement Process
– Designed Contractor/Staff Communication Process
– Implemented Advanced Procurement and Hiring Activities
• Level One Appropriation obtained April 20, 2012
Stakeholder Inclusion Operational Model
Planning Staff & Advisory
Committees
Research / Alternatives
Analysis
Planning Staff & Advisory
Committees
Research / Alternatives
Analysis
Steering Committee
Final Recommendation to Commissioner
Steering Committee
Final Recommendation to Commissioner
Advisory Committees
Develop Recommendations with Alternatives
Advisory Committees
Develop Recommendations with Alternatives
Steering Committee
The Steering Committee meets once monthly and includes representation of the following:•Insurance Department (2)•Department of Human Services (2)•Arkansas Health Agency Leaders•Department of Finance & Administration•Advisory Committee Co Chairs (6)‐•State Legislature (2)•Governor’s Office•Stakeholders At Large (3)
OctMay June July August Sept
OctMay June July August Sept
Nov
Consumer AssistanceIn-Person Assisters (IPAs)
• Categories - Navigators - Enrollment Assisters - Licensed agents and brokers (producers)
• Arkansas Insurance Department will: - Certify, recertify, decertify individual IPAs - Oversee IPA training and performance - Contract with IPA entities to facilitate enrollment and post- enrollment complaint resolution as needed
Consumer AssistanceOutreach and Education
• Outreach Education• Two Phases Planned for 2012-2013
• Phase I – General ACA/Exchange Education• Phase II – Move Eligible Residents toward Enrollment
• IPA Specialists through “Home Town Health”
• Complaint Resolution• FFE Eligibility/Enrollment• AID Consumer Services Division
Current Outreach/Education - Phase I• Interagency Contracts
UAMS Opinion Poll to guide messaging for Phase I Focus Groups to assist with “Naming/Branding” Speakers’ Bureau Initial Message Development/Media Buys
U of A Partners for Inclusive Communities County Meetings Quarterly Updates Stakeholder Summit
Staff/Consultants - IPA Outreach
In Person Assister (IPA) Entities• AID will contract with community-based IPA entities
that will engage certified IPAs
• We estimate 535 IPAs needed for initial Open Enrollment decreasing to 134 until next Open Enrollment
• Continuous, real-time feedback from the FFE will be critical in continuously assessing our successes and initiating needed improvements.
Key Dates and BenchmarksIn-Person Assisters
• IPA IT vendor selection
• IPA Program and Processes Defined by December 2012
• IPA RFP Complete by January 2013
• IPA RFP Advertised by February 2013
• IPA Awards by May 2013
• IPA Training by June 2013
• Certified IPAs in the Field July 2013
• Open Enrollment October 2013
Plan Management Activities
• Select EHB Benchmark Plan
• Define QHP Certification Criteria and Processes
• Decrease financial start up risks for issuers- Risk Adjustment- Reinsurance (temporary)- Risk Corridor (temporary)
Plan Management Processes
• Leverage Existing Processes within AID where they exist:– Life and Health– Rate Review– Consumer Services– Finance– License– Legal
• Use Enhanced SERFF System
EHB Benchmark Considerations
• Compliance with ACA• Consumer Protection• Arkansas Health Needs• Overall Premium Costs and Value• State Mandated Benefits• Wellness Benefits• Other
EHB BenchmarkRule 103 Directive 2-2012
• Arkansas Blue Cross Blue Shield Health Advantage (POS) with following Substitutions:– QualChoice Federal Plan Mental Health and Substance
Abuse Treatment Services– ARKids First (CHIP) Pediatric Dental– Blue Cross Blue Shield Federal Plan (Blue Vision High) for
Pediatric Vision
• Habilitative Services will likely be determined by carriers with State oversight
Selected Arkansas QHP Certification Criteria• Meet ACA Standards for Benefits and Actuarial Value• Increase Competition in Marketplace• Arkansas Specifics:
– Will use a certification approach for plan selection.– Will not require network adequacy or quality standards that
exceed federal ACA requirements in year one.– The Steering Committee acknowledges the emerging
importance of Arkansas’s Payment Improvement Initiative in advancing quality and affordability and the Exchange may engage or require carriers to adopt specific quality improvement strategies as a condition of having their QHPs certified to be marketed and sold on the Exchange.
Selected Arkansas QHP Certification Criteria– Will not require carriers to offer their QHPs statewide as a
condition of Exchange certification in year one, but recommends consideration of a regional approach with the goal of statewide coverage.*
– Arkansas may limit the number of plans or benefit designs that may be offered by a carrier on the exchange.*
– Pass on options related to incentivizing carriers.
* Steering Committee recommended changes from PMAC recommendation.
Expected Rules
• Network Adequacy
• QHP Certification
• In Person Assister Certification
• More
Medicaid-Exchange Integration
Continuous Coverage AcrossInsurance Affordability Programs
• How to mitigate negative effects of churning or family members in different plans
• Plan to study options using data that evaluates costs and quality by benefit design, consumer demand, and provider capacity, to include:– Current FFS– QHP Option– Medicaid Plan Option– Bridge Plan
Summary of Exchange Planning to Date• Planning Grant – Background Research;
Administrative Supplement to do Carrier Survey and more Quality Definitions
• Level One A – Contractors and Staff to begin serious Plan Management and Consumer Assistance Planning
• Level One B – Prepare for October 1, 2013 Open Enrollment and Full Implementation of Partnership Model by January 1, 2014; Study options to mitigate negative effects of IAP churning and promote continuity of coverage.
Key Milestones• Planning Review – May, 2012
• On Track; Big Take Away was that Partnership States would not issue Navigator Grants
• Long-term financial sustainability model for FFE-P unknown
• Design Review – October 1-2, 2012• CCIIO/CMS staff very helpful; Arkansas waived out of most
Blueprint items for Partnership Model• Federal officials willing to negotiate implementation issues with
state; Long-term financial issues for FFE-P not completely resolved, but state must be “paid” for service
• Blueprint Application and Declaration Letter – November 16, 2012• “Think about long- term plans” • Collaborate with other states
Key Milestones• QHP and Navigator Certification and Operational
Processes Design Complete by end of 2012
• DHHS Conditional Approval as Partnership FFE by January 1, 2013
• Implementation Review – Summer 2013
• Open Enrollment October 1, 2013 and Partnership Exchange is Fully Operational Covering Consumers by January 1, 2014
• The Future??
– Advance Planning for Hiring and Procurement – Carefully Plan Stakeholder Engagement Model;
Attract Diverse and Strong Leaders – Integrate Contractors into Planning and
Project Management– Utilize CCIIO Staff and Other Resources– Integrate with Other Health Improvement
Initiatives– Be Persistent in Relationship Building
Keep on message:• “Arkansas will not have a State Exchange”• FFE Partnership provides Arkansas:
– Ability to meet ACA deadlines for compliance with law
– Opportunity to tailor Plan Management and Consumer Assistance components to meet needs of Arkansans– Local design and implementation of Consumer Services and Protections– Funding for connecting with FFE
– Partnership with Medicaid Agency is critical
– Consider and document majority and minority opinions
– Make decisions Move on
– Keep consumer focus
Summary• Arkansas has a tremendous need for coverage expansion.• Cost, quality, and access improvements in Arkansas’s healthcare
system will benefit all Arkansans.• The Partnership Exchange allows Arkansas Insurance Department to
continue regulatory and consumer protection functions for our residents.
• Intentional efforts to mitigate negative effects of churning and promote continuous coverage will be especially important with our population.
• Transparency and inclusivity in planning is critical.• Keep consumer focus a priority.
