maryland health benefit exchange implementation advisory committee meeting september 4th, 2014

A service of Maryland Health Benefit Exchange

Maryland Health Benefit ExchangeImplementation Advisory Committee

MeetingSeptember 4th, 2014


Welcome & Approval of Minutes

Michele EberleActing Director, Plan & Partner ManagementMaryland Health Benefit Exchange


Renewal Outreach Program

Paul Barringer, Optum

MHC & 2015 Coverage RenewalsSeptember 4, 2014

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Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 5

Focused solely on health insurance and healthcare, Optum understands the purpose behind the health insurance exchanges…

…Our dedicated public sector organization brings the full set of Optum capabilities to every government customer to help the health system work better for everyone

Health Services is What Optum Does


• Optum has a proven track record in successfully supporting and remediating the federal exchange as well as in supporting a number of state health benefit exchanges.

• In Maryland, Optum/QSSI has assisted with:

Enrollments

Life events

Data analysis and reporting

Analytics support

Renewals

Optum’s Exchange Experience


Renewing Coverage for 2015: Key Considerations• Consumers who bought a health plan through Maryland Health

Connection in 2014 must renew coverage for 2015 to continue to receive financial assistance or to determine eligibility for assistance

• Consumers who would like help with renewing have multiple options for receiving assistance

• Consumers renewing independently must submit a new application at www.MarylandHealthConnection.gov by December 18, 2014 to ensure that coverage starts Jan. 1, 2015

• Consumers not successfully completing a new application at www.MarylandHealthConnection.gov will receive a bill as of January 1, 2015 showing the cost of their plan without financial assistance

http://www.marylandhealthconnection.gov/

http://www.marylandhealthconnection.gov/


Optum’s Role in Supporting Renewals• Developing and maintaining a list of individuals with effectuated QHP

enrollments; tracking renewals through old and new systems

• Coordinating with brokers/producers and connector entities to provide updated lists of consumers who elect in-person assistance

• Coordinating additional outreach (including automated dialing and email campaigns) to encourage renewal enrollments

• Supporting outreach initiatives by MHBE to encourage consumers to re-enroll in a timely basis

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.

Renewals Outreach Activities

• E-mail, letter and phone call to invite consumers to participate in tracking program and receive free in-person assistance completing their renewals application

• Social media campaign

• Paid media campaign

• MarylandHealthConnection.gov webpage will have detailed information on the renewals process

• Multiple Notices sent by MHBE throughout open enrollment and post enrollment

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Call to Action Schedule

Call to Action 2:Carriers: Nov 10-15th

- Description of redetermination and

renewal process- APTC and CSR received

in 2014- Deadline reminder for

1/1 coverage

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Call to Action 1 (Oct. 1st) from MHBE

MHBE will send a description of the annual redetermination and renewal process which addresses the following:• Individuals will need to have an eligibility redetermination – through the website,

navigator, producer or call center – to be considered for financial assistance in 2015. Those who do not have an eligibility redetermination and select a plan through the website will be automatically renewed into an exchange plan without APTC or CSR.

• Individuals will have the option to see all health plans through the new website, and may enroll in the same plan they had for 2014 or choose a different one.

• Individuals will have the ability to get assistance through producers, navigators and others for renewal through the website – and how to access such assistance.

• A description of the reconciliation process at tax time.• The requirement to report changes to information affecting eligibility and the timeframe

and channels through which changes can be reported.• The option to purchase coverage without any financial assistance by going directly to a

carrier.

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Call to Action 2 (before Nov 15th) from Carriers

Carriers will send a description of the annual financial assistance eligibility redetermination and renewal process which addresses the following:• Individuals will need to have an eligibility redetermination through the website, navigator,

or call center, to be considered for financial assistance in 2015. Those who do not have an eligibility redetermination and select a plan through the website will be automatically renewed into an exchange plan without APTC or CSR.

• A reminder of their APTC and CSR received in 2014.• The option to see all health plans through the new website.• The ability to get assistance through producers, navigators and others for renewal

through the website, and explanation on how to access such assistance.• A description of the reconciliation process at tax time.• The requirement to report changes to information affecting eligibility and the timeframe

and channels through which changes can be reported.• The option to purchase coverage without any financial assistance by going directly to

carriers.• If they take no action to get a eligibility redetermination, they will be automatically

renewed without financial assistance, including: dates of renewal period, health benefit plan rates, terms of coverage, the deadline to avoid automatic renewal.

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Call to Action 3 (~ December 1st) from Carriers

• Carriers will send a notice about the default of automatic renewal, with the premium and payment deadline.

• We will have a session with MIA to identify ways to provide this information without confusing consumers from the core message of encouraging redetermination.

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Notice CoordinationMHBE and insurance carriers share the responsibility to send notices and conduct sufficient outreach to consumers

• Consistency in message content

• Alignment in message timing

• Maximize communication to consumers

• Multiple perspectives on reasons to renew

• Opportunities to reduce redundancy and sync notices

• Ensure that all legal requirements are met

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Renewing after Open Enrollment

• After open enrollment, and on an ongoing basis, Optum will provide carriers with a list of individuals who have not renewed in the new system.

• Carriers will renew these individuals in on-exchange plans without APTC and CSR.

• Optum will continue to track individuals who did not renew in the new system through open enrollment.

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MHBE and Carrier Outreach and Coordination

Outreach Efforts to Encourage Consumers to

Renew

Consumer renews

enrollment through the new system

Consumer does not renew enrollment through the new system

Optum provides list of individuals to carriers

who did not renew through the new

system

Carriers renew individuals in on-exchange plans

without APTC or CSR for 1/1 coverage

Post 12/18, consumers

renew through the new system

Effectuate in carrier-

renewed plan

Cancelled due to non-

payment in carrier-

renewed plan

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Questions / Comments?


Renewal Timeline

Michele Eberle, Plan Management


CRISP Presentation

Jeremy Wong, CRISP

CRISP Provider Search: Open Enrollment and Error Correction UpdateSeptember 4, 2014

Current State and Open Enrollment 2014-2015

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CRISP Provider Search Website – Search by Provider

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CRISP Provider Search Website – Provider Profile

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Current State – Site Usage

Site Stats65,000 visits since 10/1/13

300 visits per day during Open Enrollment• Last week of March: 700 visits per day• March 31, 2014: 1,674 visits• December 31, 2014: 1,000 visits

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Connecticut Migration

The Connecticut system has no integrated provider data

• Consumers are linked to the carriers’ provider directory

Maryland consumers will be linked to the CRISP Provider Search site

• For Open Enrollment 2014, the CRISP Provider Search site will be the sole way to access provider data

Provider Error

Corrections

Current State – Data Flow

QHPs MCOs

Optum (P360 Data Scrubbing)

CRISP

CRISP Provider Search Maryland Health Connection

Data Submission

Provider Data Processing

Consumer Sites

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Currently, CRISP relies on carriers to make error corrections

Current Provider Error Correction Process1. Providers report errors to CRISP2. CRISP determines which carrier(s) submitted

the error3. Each month, CRISP submits a Provider Error

Report to each carrier4. Carriers follow-up with providers to resolve

errors5. Carriers correct errors in subsequent bi-

weekly submissions to CRISP

Provider Error

Corrections

Open Enrollment – Data Flow

QHPs MCOs

Optum (P360 Data Scrubbing)

CRISP

CRISP Provider Search

Data Submission

Provider Data Processing

Consumer Sites

Error Correction Initiative

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CRISP has received various feedback detailing inaccuracies in provider data

Provider errors can be divided into two categories:

• Demographics errors involve providers’ addresses, phone numbers, and office hours

• Network errors involve specialty and disputed inclusion in a carrier’s network

CRISP is currently conducting an Error Correction Pilot

Unified portal where providers can view carrier-submitted information and submit updates

• Demographics corrections (addresses, locations, and office hours) can be made immediately

• Network corrections would be submitted to the appropriate carrier(s)

CRISP is developing provider identity proofing

The Error Correction functionality is on-target to be live by late 2014.

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Error Correction Pilot

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CRISP will develop appropriate “trust levels” with Optum to ensure corrections made align with MHBE business goals

Develop “trust levels” with Optum to determine which provider information is displayed

• Optum will trust CRISP data (over carrier data) for approved demographics fields and make real-time corrections

• Optum will trust MCOs and QHPs for network corrections

Automated Carrier Error Reports

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CRISP is developing methodology for sending automated Error Reports to carriers

Proposed File RequirementsDistinguish between Demographics and Network Corrections

• Carriers should update provider information based on Demographics Changes

• Carriers should adjudicate Network Changes with carrier and make changes in subsequent CRISP Input Files

Identify if information should be added or removed for a provider

The text file will be delivered to a SFTP location every day for which there is an error correction submitted to CRISP for that carrier.

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CRISP recommends a pipe-delimited flat file

Proposed File Format

1. CRISP proposes a pipe-delimited text file.

2. The file will include identifying information about the provider (e.g., first name, last name, and NPI)

3. Corrections will be tagged as either as “Demographics” or “Network.”

4. Corrections will be tagged with “add” or “remove” – followed by the relevant piece of information.

Demographics|Remove|Address|1 Main St.||Columbia|MD|21046|4435551212Network|Add|Specialty|Cardiology Network|Remove|All CareFirst plans

Next Steps

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Next Steps

1. CRISP will distribute a final Error Correction File Format and Delivery document

2. Carriers can respond with questions or suggestions

3. When development is complete, CRISP will invite carriers to test functionality and provide feedback


HIX Update

Nabila Rahman, Optum


MHBE IACSystem Update

September 4, 2014

Glossary

SIT – System Integration Testing

UAT – User Acceptance Testing

EDI – Electronic Data Interchange

Release 1 – Plan Management

Release 2 – Eligibility & Enrollment

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Agenda

System Implementation Timeline

Release 1 UAT

Release 2 SIT & UAT

Meetings

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System Implementation Update - Timeline

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UAT

Today

Release 1 UAT

Last week, carriers should have received – Rate data extract– Benefit data extract

Benefit data extract contains multiple errors– New file will be emailed by COB Friday, September 5– Submit feedback by COB Wednesday, September 10

Continue validating rate data– Submit feedback by COB Friday, September 5– Received feedback that the rate extract is rounding incorrectly. Continue to

validate and let us know if you see this issue.

Submit Individual SBCs by September 10

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Release 2

SIT– Received feedback from the emailed screenshots of plan shopping experience

from SIT environment.• Investigating your feedback.

– Ongoing EDI 834 testing – please reach out if you have concerns

UAT– Thank you for submitting names for onsite testing.– September 15 – September 19: individual meetings with each carrier to walk

through portal– September 22 – October 3: unstructured carrier UAT testing

• Access to anonymous browsing• Ability to confirm rates and plan display

– October 13 – October 17: structured carrier UAT testing• Full access to end-to-end system – hitting the FDSH, identity proofing, generating 834s,

etc.• Utilize MHBE-defined scripts

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Meetings

Daily EDI 834 testing calls (short term)

Weekly Plan Management and Operational calls

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SHOP Update

Stephanie Lee, MHBE Plan Management


Dental Updates

Michele Eberle, MHBE Plan Management

Renewal of 2014 SADP’s

Tax subsidies have been rarely applied to dental policies per the National Association of Dental Plans (NADP)

Dental benefits maintain a HIPAA-excepted benefit status

Dental benefits are exempt from guaranteed renewability

Renewal notices are not applicable to SADP’s, but NADP has encouraged members to use them

The FFM is including SADPs in their auto-renewal process

Md. Insurance Code Ann 15-122 (a) (4) includes the renewal requirements for carriers and defines carriers as including dental plans

About 7000 consumers purchased SADP’s through MHC in 2014, mostly family dental plans

CMS is borrowing the uniform modification of coverage test for the purposes of recertification of SADP’s [CMS FAQ 2639, 7/3/14]

Renewal of 2014 SADP’s

If a consumer wishes to reenroll and maintain their QHP but change their SADP, how will the consumer be instructed to do so?

If a consumer wishes to maintain their SADP but change their QHP, how will the consumer be instructed to do so?

How will reenrollments occur if a consumer does not come back through the MHC website for reenrollment? Will coverage end? Will dental carriers need to automatically re-enroll in the same plan?

What reporting requirements will MHBE have of dental carriers for renewing members?

Are dental carriers to planning to send notices to members regarding reenrollment?

Items being addresses


2015 Dental Plan Display

Michele Eberle, MHBE Plan Management

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NEXT MEETING:

September 18th, 2014

2:00 – 4:00PM

UMBC Tech Center

PUBLIC COMMENTS?

maryland health benefit exchange implementation advisory committee meeting september 4th, 2014

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