1332 State Innovation Waiver Post Award Forum October 24 2019 Department of Consumer and Business Services HB 2391 establishes the Oregon Reinsurance Program Sections 18 to 25 Purposes Help stabilize rates and premiums for individual health benefit plans ID: 1044228
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1. Oregon Reinsurance Program1332 State Innovation Waiver Post Award ForumOctober 24, 2019Department of Consumer and Business Services
2. HB 2391 establishes the Oregon Reinsurance Program (Sections 18 to 25). PurposesHelp stabilize rates and premiums for individual health benefit plans. Provide greater financial certainty to consumers.All enrollees in non-grandfathered individual health benefit plans are eligible. HB 2391 (2017)
3. Attachment point model Claims between an attachment point and reinsurance cap will be reimbursed at the coinsurance rate. Attachment point and cap cannot change within a benefit year.Coinsurance rateHB 2391 (2017)
4. January 1,2019 DCBS adopted ORP rules necessary to carry out the program, including:June 30, All eligible Health Care claims paid by Insurers ($95,000 to $1 million) July 15 Submit all eligible claims for reimbursementAudits conducted by DFR Insurers must identify impact of reinsurance payments in their rate filings annually. HB 2391 (2017)
5. Three Sources: One time state funds transfers Excess balance from Oregon Health Insurance ExchangeRemaining balance of the Oregon Medical Insurance Pool AccountA portion of the 1.5% health benefit plan premium assessment created under HB 2391.Federal pass-through funding received under Oregon’s Section 1332 waiver. Reinsurance Funding
6. Oregon’s 1332 WaiverOregon applied for a Section 1332 waiver to help fund the Oregon Reinsurance Program Requested a wavier of the ACA single risk pool requirement to allow carriers to adjust individual rates downward to account for reinsurance. Requested a “Pass-through” of federal savings attributable to reinsurance. These savings come from reductions in federal spending on premium tax credits.
7. CMS approved Oregon’s application on October 19, 2017 for 5 years. Federal savings= Pass-Through Funding by Year: -2018= $54,482,113 -2019= $41,845,226 Additional information: https://www.cms.gov/cciio/programs-and-initiatives/state-innovation-waivers/section_1332_state_innovation_waivers-.htmlOregon’s 1332 Wavier
8. Projected per year$90 million in 2018$95.4 million in 2019 Funding for 2020 and beyond contingent on available funds.ORP - Projected Annual Budget
9. March 13, 2019- HB2010 passed ORP extend 2020-2026July 2019- Actual claims totaled $76,750,754October 2019– $90 million in Health care claims reimbursed ORP - High Level Timeline
10. Reinsurance Cap - $1MCoinsurance – 50% (2018 Adjusted to 59.2%)Attachment points 2018 – $95,0002019 - $90,0002020 - $90,000Proposed Payment Parameters
11. ORP – Effect on Individual Rates As a result of the Oregon Reinsurance Program, rates were reduced by an average of 6 percent with the PPACA 1332 waiverFor 2020, carriers have included the impact of reinsurance in their individual rate filings. 2020 will save Oregonians over $95.4 million in Health care premiums.Similar market wide impacts are expected. Additional Information: https://dfr.oregon.gov/news/2019/Pages/20190715-2020-final-rates.aspx
12. Questions?