Exchange explanations by twincities


									                                        QUESTIONS & ANSWERS

                           Understanding Exchange Certification Application
                                                September 18, 2012

What does Minnesota have to submit in its application to the U.S. Department of Health and Human
Services (HHS) on November 16, 2012?

       HHS has provided a step-by-step application blueprint for states developing health insurance exchanges. An
       overview of blueprint requirements provided by HHS is attached to this document. By November 16,
       Minnesota must submit an application following that blueprint that includes the following:

              Information to document the blueprint requirements Minnesota has completed
              A plan and timeline for completing all remaining blueprint requirements

To satisfy the requirements of the November 16 application, does Minnesota have to make final policy
decisions on issues like governance, long-term financing, and agent/broker compensation?

       No. Minnesota will not commit to any final policy decisions in this application, such as how it will be financed
       or its permanent governance structure.

       Due to the great flexibility of the federal approval process, Minnesota can request conditional approval in
       November, and then make these important policy decisions early in the 2013 Legislative Session. Governor
       Dayton respects the authority of the Legislature to participate in these decisions, and strongly prefers that
       we all work together to make these crucial choices.

When will HHS respond to Minnesota’s application?

       HHS is required to respond to Minnesota’s application no later than January 1, 2013. HHS can grant either:

              Full approval
              Conditional approval
              Disapproval

What does it mean to receive conditional approval?

       HHS may grant conditional approval if a state can demonstrate that significant progress has been made on
       the blueprint requirements and that the remaining blueprint requirements can be completed within a timeline
       that ensures that the exchange is ready for the open enrollment period on October 1, 2013. A state that
       receives a conditional approval is expected to sign an agreement outlining steps that need to be
       accomplished to keep development efforts on track to meet all exchange deadlines.

What next steps are planned to solicit public input and complete Minnesota’s application?

       All blueprint documents and Work Group and Task Force recommendations will be posted online for public
       comment. Public comments will be submitted via email and comments received will be posted online. Over
       the next several months, the Exchange Advisory Task Force and its work groups will continue discussions
       around key blueprint items and issue recommendations. A full timeline for this work is attached.

States have been directed to use this blueprint, provided by HHS, in their November 16 applications for certification.
Minnesota has already satisfied some of these requirements in its May design review with HHS. The state may
modify or amend information submitted with the design review or in its November 16 application.

    Legal Authority and Governance
         Enabling authority for exchange and governance
         Board and governance structure

    Consumer and Stakeholder Engagement/Support
         Stakeholder consultation plan
         Tribal consultation plan
         Outreach and education
         Call center
         Internet website
         Navigators
         In-person assistance program
         Agents/brokers
         Web brokers

    Eligibility and Enrollment
          Single streamlined application(s) for exchange and SHOP
          Coordination strategy with Insurance Affordability Programs and SHOP
          Application, updates, acceptance, and processing and responses to redeterminations
          Notices, data matching, annual redeterminations, and response processing
          Verifications
          Document acceptance and processing
          Eligibility determination
          Eligibility determinations for APTC and CSR
          Applicant and employer notification
          Individual responsibility requirement and payment exemption determinations
          Eligibility appeals
          QHP selections and terminations, and APTC/advance CSR information processing
          Electronically report results of eligibility assessments and determinations
          Procedures established in accordance with Pre-Existing Condition Insurance Plan transition

    Plan Management
          Appropriate authority to perform and oversee certification of QHPs
          QHP certification process
          Plan management system(s) or processes that support the collection of QHP issuer and plan data
          Ensure ongoing QHP compliance
          Support issuers and provide technical assistance
          Issuer recertification, decertification, and appeals
          Timeline for QHP accreditation
          QHP quality reporting

    Risk Adjustment and Reinsurance
         Risk adjustment program
         Reinsurance program

    SHOP
         SHOP compliance with 45 CFR 155 Subpart H
         SHOP premium aggregation
         Electronically report results of eligibility assessments and determinations for SHOP

    Organization and Human Resources
         Organizational structure and staffing resources to perform Exchange activities
 Finance and Accounting
       Long-term operational cost, budget, and management plan

 Technology
      Compliance with HHS IT Guidance
      Adequate technology infrastructure and bandwith
      IV&V, quality management and test procedures

 Privacy and Security
       Privacy and Security standards policies and procedures
       Safeguards based on HHS IT guidance
       Safeguard protections for federal information

 Oversight, Monitoring and Reporting
      Routine oversight and monitoring of the Exchange’s activities
      Track/report performance and outcomes metrics related to Exchange activities
      Uphold financial integrity provisions including accounting, reporting, and auditing procedures

 Contracting, Outsourcing and Agreements
      Contracting and outsourcing agreements

 State Partnership Exchange Activities
       Plan management
       Capacity to interface with the federally-facilitated Exchange
       Consumer assistance
                                     TIMELINE & MILESTONES

                               Ongoing Exchange Development Efforts
                                                  Fall 2012
This document outlines a specific timeline for ongoing exchange development efforts for the period of
September – December 2012, setting key milestones and expectations for continued progress. This schedule
is flexible and subject to modification.

       September – ongoing    Public Comment
                                  All Blueprint documents and Work Group and Task Force
                                     recommendations posted online for public comment
                                  Public comments invited to be submitted via email
                                  All public comments received will be posted online

       September 27           Health Insurance Exchange Advisory Task Force Meeting
       10am-noon                  Discuss Exchange Tribal provisions
       Fond du Lac                Tribal Consultation
       Reservation                Plan Certification Sub Group recommendation: qualified health plans
                                      (QHP) and issuer standards
                                  Update on IT development progress
                                  Discuss process moving forward
                                  Provide opportunity for public comment and testimony

       October 1              Governor’s Health Reform Task Force Meeting
       2:30-5:00pm                Joint meeting of the Governor’s Health Reform Task Force and the
       Wilder Center                Exchange Advisory Task Force
       451 Lexington Pkwy N       Walk through Exchange Blueprint
       Saint Paul, MN                   o Discuss process, requirements and levels of approval
                                  Walk through existing grant budgets
                                  Discuss/outline process moving forward
                                  Provide opportunity for public comment and testimony

       October 10             General Public Meeting
       9am-12pm                   Joint meeting: Exchange Advisory Task Force and Governor’s Health
       Location Pending              Reform Task Force members invited
                                  Present Minnesota Exchange progress to date
                                        o Present CCIIO feedback/status from May design review
                                        o Discuss open areas/policy options
                                  Walk through new grant budget
                                  Update/outline moving forward
                                  Provide opportunity for public comment and testimony

       October 24             Health Insurance Exchange Advisory Task Force Meeting
       9am -12pm                  Adverse Selection Work Group recommendations: risk adjustment
       Location Pending           Navigator and Agent/Broker Work Group recommendations: levels of
                                      service and training/ certification/ licensure requirements
                                  Finance Work Group report: funding options
                                  Update on IT development progress
                                  Blueprint Discussion
                                  Task Force process moving forward
                                  Provide opportunity for public comment and testimony
November TBD   Health Insurance Exchange Advisory Task Force Meeting
                   Small Employers and Employees Work Group report
                   Adverse Selection Work Group report
                   Plan Certification Work Group recommendation: stand alone dental
                   Update on IT development progress
                   Blueprint Submission
                   Provide opportunity for public comment and testimony

December TBD   Health Insurance Exchange Advisory Task Force Meeting
                   Outreach and Marketing Work Group report
                   Navigator and Agents/Brokers Work Group recommendations:
                   Measurement and Reporting Work Group report: quality rating and
                       enrollee satisfaction
                   Update on IT development progress
                   Task Force and work group process and structure moving forward
                   Provide opportunity for public comment and testimony

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