Presentation on theme: "Washington State"— Presentation transcript
Slide1
Washington StateHealth Insurance Exchange
Phil DyerBoard MemberSlide2
Disclaimer;
The views and information expressed are my personal opinions and perspectives and do not represent the official position of the State of Washington or the Washington State Health Insurance Exchange Board or Staff.Slide3
The WA Health Insurance Exchange
As laid out in Substitute Senate Bill 5445, twenty nominations for the Exchange Board were submitted by the house and senate caucuses and included individuals with expertise in individual health care coverage, small employer health care coverage, health benefits plan administration, health care finance and economics, actuarial science, and/or administering a public or private health care delivery system. Initial
members of the board will serve staggered terms not to exceed four years.
On March 15th, 2012, the Board assumed governing authority over the Exchange.Slide4
The WA Exchange Board
Chair: Margaret Stanley,
retired Executive Director of the Puget Sound Health Alliance, and former Senior Vice-President at Regence BlueShield and head of public employee benefits programs in both Washington and California
(Non Voting with exception of Tie Votes)
Ben
Danielson,MD
Medical
Director at the Odessa Brown Children's Clinic
Bill Baldwin
, Partner, The Partners Group
Don Conant
, General Manager at Valley Nut and Bolt in Olympia and Assistant Professor in the School of Business at St. Martin's University
Doug Conrad
, Professor of Health Services at the University of Washington School of Public Health
Melanie Curtice
, partner in the employee benefits section at the law firm of
Stoel
Rives LLP
Phil Dyer
, Senior Vice President at Kibble & Prentice/USI and former state legislator
Steve Appel
, wheat and barley farmer and immediate past-President of the Washington Farm Bureau
Teresa Mosqueda
, Legislative and Policy Director for the Washington State Labor Council and Chair of the Healthy Washington Coalition
Ex-Officio
:
MaryAnne Lindeblad
,
Director of the Health Care Authority
Ex-Officio
:
Mike
Kreidler
, Washington State Insurance Commissioner Slide5
WA Exchange Board Goals
Increase access to affordable health plans.Organize a transparent and accountable insurance market -- to facilitate consumer choice.Provide an efficient, accurate and customer-friendly eligibility determination process.Enhance health plan competition on value -- price, access, quality, service, and innovation.Slide6
WA Exchange Major Committees
Operations Chair, Melanie CurticeSteve Appel
Bill Baldwin
Don Conant
Margaret Stanley
Policy
Chair, Teresa Mosqueda
Doug Conrad
Ben Danielson
Phil Dyer
Margaret StanleySlide7
Exchange Board Advisory Committee
May 16, the Exchange Board selected 17 committee members to provide expertise and experience on an array of issues related to developing the Health Benefit Exchange in Washington State. Those members include
:
American Indian Health Commission (AIHC) Representative
Sharon
Beaudoin, WithinReach
Ted
Blotsky, Employee Benefit Services-Associated Employers Trust
Glen
Bogner, Molina Healthcare
Kitti
Cramer, Premera
Mike Fournier, Washington Farm Bureau
Patty Hayes, Public Health – Seattle & King County
Dhyan Lal, Providence Health & Services
Mary McWilliams, Puget Sound Health Alliance
Karen
Merrikin, GroupHealth Cooperative
Hiroshi Nakano, South Sound Neurosurgery
Pam
Oliver, Community Member
Jim
Pinkerton, Regence
Donna
Steward, Association of Washington Business
Larry
Thompson, Whatcom Alliance for Healthcare Access
Washington
Association of Health Underwriters (WAHU) Representative
Joshua
Welter, Mainstreet AllianceSlide8
Exchange Board Technical Advisory Committees
Dental Technical Advisory Committee
· Dr. Christopher Delecki – Odessa Brown Children’s Clinic
· David Digiuseppe – Community Health Plan of Washington
· Bracken Killpack - Washington State Dental Association
· Dr. Alejandro Navarez – Sea Mar CHC
· Dr. Brian Schur – Tri-Cities Community Health Center
· Chris Smith – Regence BlueShield
· Delta Dental Washington Dental Service Foundation Representative
Navigator Program Technical Advisory Committee
· Sofia Aragon – Washington State Nurses Association
· Pam Cowley – Tacoma-Pierce County Health Department
· Rhonda Hauff – Yakima Neighborhood Health Services
· Devon Love – Equal State Community Coalition for Multicultural Health
· Vicki Lowe – Jamestown S’Klallam Tribe
· Michelle Sarju – Open Arms Perinatal Services
· Lara Welker – Whatcom Alliance for Healthcare Access
Role of Agents/Brokers Technical Advisory Committee
· Lonnie Goodell – Group Health Cooperative
· Dave Guyll – Conover Insurance
· Bryan Marsh – Regence BlueShield
· Nita Petry – Gallagher Benefit Services, Inc.
· Harald Schot – LifePlan Financial Inc.Slide9
Health Care National Spending(Deloitte)
This year, the federal government will take in about $2.4 trillion and spend about $3.6 trillion—the fourth year in a row of the deficit exceeding $1 trillion.
Spending
for health care programs
—
Medicare
,
Medicaid
,
Children’s Health Insurance Program
(CHIP
), military health
,
federal employee coverage
—will be almost
one-fourth of the government’s outlays and a third of all government revenues from taxes paid by individuals and companiesSlide10
State Action Toward Creating Health Insurance Exchanges
As of August 24, 2012Slide11
11
Washington is a Leading State in the Process of Securing $178 Million for Exchange Establishment & Medicaid Eligibility SystemsSlide12
Exchange Functions
Certifying health plans as “Qualified Health Plans” to be offered in the exchange.The final rule allows Exchanges to work with health insurers on structuring qualified health plan choices that are in the best interest of their customers. This could mean that the Exchange allows any health plan meeting the standards to participate or that the Exchange creates a competitive process for health plans to gain access to customers on the Exchange
Standards for Health
Plans
Exchanges, working with state insurance departments, to set specific standards to ensure that each qualified health plan gives consumers access to a variety of providers within a reasonable amount of time. Exchanges will also establish marketing standards to make sure that qualified health plans do not market plans in a way that discriminates against people with illnesses. Slide13
Operating
a website to facilitate comparisons among qualified health plans for
consumers
Operating
a toll-free hotline for consumer support, providing grant funding to entities called “Navigators” for consumer assistance, and conducting outreach and education to consumers regarding Exchanges
Exchange Functions
Consumer InteractionsSlide14
Exchange Functions
Determining eligibility of consumers for enrollment in qualified health plans and for insurance affordability programs (premium tax credits, Medicaid, CHIP and the Basic Health Plan)
Eligibility Determinations
Exchanges to consider whether consumers are eligible for all available programs using a single, streamlined application
Simple Verification of Data
Exchanges to rely on existing electronic sources of data to the maximum extent possible to verify relevant information, with high levels of privacy and security protection for consumers.
Coordinating across Programs:
The final rule ensures that Exchanges will coordinate with Medicaid, CHIP, and the Basic Health Program Slide15
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Exchange Value – Specific Functions
I. Issuers of QHPs
II. Health Care Market
III. Public and State
Marketing & Outreach
Eligibility Determination for tax credits
Enrollment
Premium Aggregation
Easy plan comparison and purchase of health insurance
Reporting of cost/quality metrics
Awareness of need for health insurance
Appeals of eligibility determinations and individual responsibility
Information on health insurance carriers
Customer Service
Enrollment reconciliation with HHS
New Membership opportunity – previously uninsured
Supporting use of innovative product designs and payment methodologies
Expanded access to health insurance coverage
Reduced charity care
Trustworthy source of health care reform information
Broad-based Public Information
Other impacts of ACASlide16
Exchange Functions
Exchanges to build partnerships with and award grants to entities known as “Navigators”
who will reach out to employers and employees, consumers, and self-employed individuals to
:
Conduct public education activities to raise awareness about qualified health plans
Distribute fair and impartial information about enrollment in qualified health plans, premium tax credits, and cost-sharing reductions
Assist consumers in selecting qualified health plans
Provide referrals to an applicable consumer assistance program or ombudsman in the case of grievances, complaints, or questions regarding health plans or coverage
Provide information in a manner that is culturally and linguistically appropriate Slide17
Exchange Functions
SMALL BUSINESS HEALTH OPTIONS (SHOP)
Exchanges will operate a
Small Business Health Options Program
(
SHOP
). SHOP will allow employers to choose the level of coverage they will offer and offer the employees choices of all qualified health plans within that level of coverage. This allows employees a choice among plans and can select the one that best fits their needs and their budget. Employers can offer coverage from multiple insurers, just like larger companies and government employee plans, but get a single bill and write a single check. SHOP Exchanges can also allow employers to select a single plan to offer its employee
Starting in
2014
, small employers purchasing coverage through SHOP may be eligible for a tax credit of up to 50% of their premium payments if they have 25 or fewer employees, pay employees an average annual wage of less than $50,000, offer all full time employees coverage, and pay at least 50% of the premium. Slide18
18
Coverage Continuum in 2014
3
4
* Federal Basic Health Plan Option for individuals with incomes between 138% and 200% of the FPL will not be available in 2014.
*Slide19
19
SSI Presumptive
Medical Care Services Program
Basic Health Plan
ADATSA
Involuntary Treatment Act
Psych. Indigent Inpatient Program
Take Charge Family Planning
Family Planning Extension
CHIP
Medicaid Standard
Medicaid Benchmark
CHIP
Medicaid Standard
QHP with Subsidy
To-Be Landscape: Continuous Coverage
Note: Transition options to be addressed by State Legislature.
QHP without SubsidySlide20
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Post Implementation of the Affordable Care Act (ACA):
Subsidized Coverage Landscape in Washington
344
Individuals (in thousands)
Note: Analysis forecast assumes full take up rate and the ACA was in effect in 2011. **Includes individuals who have access to other coverage (e.g., employer sponsored insurance). Sources: The ACA Medicaid Expansion in Washington, Health Policy Center, Urban Institute (May 2012); The ACA Basic Health Program in Washington State, Health Policy Center, Urban Institute (May 2012) ; Milliman Market Analysis; ‘and Washington Health Care Authority for Medicaid/CHIP enrollment.
2012
1.16 million
current enrollees
2014
545,000
currently eligible but not enrolled**
494,000
newly eligible
532,000
eligible for subsidiesSlide21
21
Post Implementation of the ACA: Remaining Uninsured
Undocumented immigrants
Individuals exempt from the mandate who choose to not be insured (e.g., because coverage not affordable)
Individuals subject to the mandate who do not enroll (and are therefore subject to the penalty)
Individuals who are eligible for Medicaid but do not enrollSlide22
THE “METALLICS”
Four Levels of Benefits
Bronze
Silver
Gold
PlatinumSlide23
Exchange Functions
Apply the Essential Health Benefit Plan Levels established by Essential Health Benefits QHP’s must include items and services within at least the following 10 categories:
Ambulatory patient services
Emergency services
Hospitalization
Maternity and newborn care
Mental health and substance use disorder services, including behavioral health treatment
Prescription drugs
Rehabilitative and habilitative services and devices
Laboratory services
Preventive and wellness services and chronic disease management, and
Pediatric services, including oral and vision careSlide24
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Timeline of Key Tasks: Much Work To Be Done
2012
2013
2014
Oct 1 2013:
Open enrollment begins.
Jan 1 2014:
Exchange goes live.
July 1 2013:
Finalize QHP contracts.
October 2012:
Complete business rules and workflow for all eligibility & enrollment operations.
Jan 1 2013:
Receive conditional or full exchange certification from Secretary.
QHP solicitation bids due.
Initiate marketing & outreach campaign.
Launch assisters training program.
Nov 2014:
Last Exchange Establishment application deadline.
Nov 16, 2012: Request federal certification for Exchange operations.
Dec 31 2014:
Exchanges must be self-sustaining.
Sept 30 2012:
Deadline to select benchmark Essential Health Benefits plan.
Aug 15, 2012:
First of ten new opportunities to apply for Exchange grantsSlide25
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To Learn More About the Exchange
Contact:
http://www.hca.wa.gov/hbe
Includes information about:
Exchange Board
Legislation and grants
Policy discussion
TAC and stakeholder involvement
IT systems development
HHS guidance
Listserv registrationSlide26
Questions
