; Workgroup Idaho Health Insurance Exchange Idaho gov
Learning Center
Plans & pricing Sign in
Sign Out
Your Federal Quarterly Tax Payments are due April 15th Get Help Now >>

Workgroup Idaho Health Insurance Exchange Idaho gov


  • pg 1
									      State of Idaho
Health Insurance Exchange
  Governance Workgroup Meeting

          May 26, 2011
           Workgroup Goal
Develop draft proposed legislation for an Idaho
Health Insurance Exchange to define type of entity,
governance structure, and authority of governing

The Department of Insurance and Department of
Health and Welfare seek your input on this process.

     How will we get there?
1. Define the type of entity for an Idaho Health Insurance
2. Define recommended governance structure for an Idaho
   Health Insurance Exchange
3. Define governance roles, responsibilities, and authority
   for an Idaho Health Insurance Exchange
4. Conduct a public comment period on proposed health
   insurance exchange-enabling legislation
5. Incorporate public comment
6. Define any additional legal or legislative actions that
   would need to occur in order to plan for the
   establishment of the Idaho Health Insurance Exchange

            Goals for Today
• Achieve a common understanding of what is
  needed in Idaho Exchange-enabling legislation

• Begin to gather ideas on governance and powers of
  an exchange

            Legislation Dates
1.   May 2 – August 9: Agency submits ideas
2.   August 2 - Last day legislative ideas due to Governor’s
3.   Sept 17 – Last day approved proposed legislation due to
     Governor’s office
4.   November – Bills returned to agency for review and final
5.   December 3 – Final date for any changes to bills
6.   January – All approved legislation delivered to House and
     Senate the first week of January

Timeline – Latest Dates

     Legislation Considerations
1.    No reference to the federal health care reform
      legislation or federal health insurance exchange
      requirements in Idaho exchange‐enabling legislation
2.    Simple, limited language has higher likelihood of passing
      through legislature
3.    Time is of the essence – get a draft circulating ASAP

    Exchange Entity Considerations
Model           Advantages                                 Disadvantages
                   Direct link to the State                  Risk of the Exchange’s decision-making and
                    administration, and a more direct          operations being politicized;
                    ability to coordinate with other key      Possible difficulty for the Exchange to be
State Agency        State agencies, such as the State          nimble in hiring and contracting practices,
                    Medicaid agency and Department             given most States’ personnel and
                    of Insurance.                              procurement rules.

                   Possible exemption from State             Possible difficulty for the Exchange to
                    personnel and procurement laws;            coordinate health care purchasing strategies
                   More independence from existing            and initiatives with key State agencies, such as
                    State agencies, which could result         the State Medicaid agency and the State
Independent         in less of a possibility of the            insurance department and relevant State
Public Entity       Exchange being politicized.                employees (unless those decisions are subject
                                                               to the approval of a State official, such as the
                                                               State insurance commissioner or the

                   Flexibility in decision making;           Isolation from State policymakers and key
                   Less likely for decisions to be            State agency staff;
Non-profit          politicized;                              Potential for decreased accountability;
Entity             May provide better avenue for             Potential higher cost to establish vs. using
                    grant funding;                             existing structure.
                   Outside State hiring process.

     Legislation Considerations -
1.    Extent to which legislation grants authority to Exchange
      Board to develop plan of operation, and establish rules,
      conditions, and procedures
2.    Ability of Exchange to enter into contracts, secure
      funding, borrow money, impose assessments, hire staff,
      procure resources
3.    Board selection; appointments, elections
4.    Member qualifications, expertise needed, specific
      stakeholder interests to be represented
5.    Board size

 Legislation Considerations -
6.    Terms & Vacancies
7.    Conflicts of interest
8.    Voting rights, non-voting members
9.    Role of governing body in Exchange development – level
      of involvement
10.   Use of advisory boards
11.   High Risk pool Model?
12.   Powers, Liability
13.   Board compensation, expense reimbursement
14.   Day to day administration

Board Expertise Considerations
 o   Individual health insurance coverage
 o   Small employer health insurance
 o   Health benefits administration
 o   Healthcare finance
 o   Administration of public and private health care delivery
 o   Purchase of health insurance coverage
 o   Provision of health care services
 o   Health care economics
 o   Health care actuarial science
 o   Information technology
 o   Small businesses < 50 employees

    NAIC Model Act Overview
o   Section 1. Title
o   Section 2. Purpose and Intent
o   Section 3. Definitions
o   Section 4. Establishment of Exchange
o   Section 5. General Requirements
o   Section 6. Duties of Exchange
o   Section 7. Health Benefit Plan Certification
o   Section 8. Funding; Publication of Costs
o   Section 9. Regulations
o   Section 10. Relation to Other Laws
o   Section 11. Effective Date

  Section 2. Purpose and Intent

• Establishes Exchange for Individual and SHOP
  market to facilitate the purchase and sale of
  qualified health plans and assist with enrollment

• Defines intent of Exchange
   – Reduce uninsured, market transparency, consumer
     education, access to premium assistance tax credits and
     cost sharing reductions

        Section 3. Definitions
• Defines the following:
   –   an educated health care consumer
   –   health benefit plan
   –   health carrier
   –   qualified dental plan
   –   qualified employer
   –   qualified health plan
   –   qualified individual
   –   SHOP Exchange
   –   a small employer

    Section 4. Establishment of
• Official title of Exchange
• Type of entity
• Exchange function
• Ability to contract with eligible entities to
  perform any of its functions
• Definition of such an eligible entity
• Ability to enter into information-sharing

Section 5. General Requirements

• Exchange shall only make qualified health plans
• Exchange shall allow limited scope dental benefits
  according to the ACA
• Exchange may not assess penalty for individual
  coverage termination if otherwise eligible, or if
  employer-sponsored coverage becomes

 Section 6. Duties of Exchange

• Implement procedures for health plan
  certification, recertification, and decertification
• Provide for 1-800 hotline
• Establish an electronic calculator
• Establish a SHOP Exchange
• Select entities qualified to serve as Navigators
• Maintain accurate accounting and submit annual
• Consult with stakeholders
• Etc………..

        Section 7. Health Benefit
           Plan Certification
• Many references to the Federal Act
    –   Essential health benefits package
    –   Levels of coverage (metal levels)
    –   Cost sharing requirements
    –   Plan network adequacy, marketing practices, quality
        improvement, etc.
• Provisions for plan exclusions
• Requirements of a health carrier seeking certification as a
  qualified health plan
• Premium increases
• Public information requirements
    – Claims payment, enrollment, disenrollment, rating practices,
• Health plan exemptions
• Dental benefit provisions      18
 Section 8. Funding; Publication
             of Costs
• Charging of assessments to generate funding to support
  Exchange operations
• Publishing of costs of licensing, regulators fees, and
  administrative costs of Exchange

         Section 9. Regulations
• Powers of exchange to promulgate regulations that do
  not conflict with those promulgated by the Secretary
  under the Federal Act

        Section 10. Relation to
              Other Laws
• Exchange legislation should not preempt or supersede
  the authority of the commissioner to regulate the
  business of insurance within the State

    NAIC Model Act Overview
o   Section 1. Title
o   Section 2. Purpose and Intent
o   Section 3. Definitions
o   Section 4. Establishment of Exchange
o   Section 5. General Requirements
o   Section 6. Duties of Exchange
o   Section 7. Health Benefit Plan Certification
o   Section 8. Funding; Publication of Costs
o   Section 9. Regulations
o   Section 10. Relation to Other Laws
o   Section 11. Effective Date

    Other State Approaches
o A few interesting legislation approaches from
  other states


State Legislation on Exchanges

                    State Exchange
                  Legislation Activity
•   Virginia’s HB 2434 passed the legislature and signed into law by
    Governor McDonnell
     –   The law states Virginia’s intent to establish and operate its own Exchange.
     –   Requires the Secretary of Health and Human Resources to work with the Assembly,
         experts, and stakeholders to provide recommendations on various issues for the
         2012 session

•   Hawaii’s SB 1348 passed on May 6 and is expected to be signed by
    Governor Abercrombie
     –   The bill establishes the Exchange as a nonprofit and creates a board of directors

•   North Dakota’s HB 1126 passed both houses of the legislature on
    April 27 and Governor Dalrymple supports
     –   Bill authorizes the insurance department to work with the state human services
         department to plan the Exchange and allows the state to seek additional federal
         funding for Exchange

                    State Exchange
                  Legislation Activity
•   Colorado’s SB 200 establishes the Exchange as a nonprofit public
    entity with a board of directors
     –   The bill passed the Senate, then House, and received final approval from the
         Senate on May 5. Governor Hickenlooper supports the legislation.

•   Vermont’s H 202 establishes an Exchange under an existing state
    agency. The “Green Mountain Care” program designed to ultimately
    create a single-payer health system
     –   Bill passed both House and Senate, and went to conference in order to reconcile
         different versions. Conference committee came to agreement and bill received
         approval on May 5. Governor Shumlin is expected to sign.

•   Arkansas and Mississippi unable to pass Exchange enabling
     –   Looking at alternative options: housing Exchange within an existing program or
         issue an executive order. i.e. Indiana’s Governor Daniels issued an Executive Order
         in January establishing a state Exchange

  State Legislation Example 1: Nevada
“Silver State Health Insurance Exchange”
• Entity, Governance
   –   Quasi Governmental Agency/Free standing
   –   Board of 10 – 7 voting & 3 ex officio non-voting
   –   Governor appoints 5 voting members
   –   Senate Majority Leader appoints one voting member
   –   Assembly Speaker appoints one voting member
   –   The Board elects a chair & vice chair for 1-year terms
   –   The Board will appoint an Executive Director to run administration and
       hire/fire employees

• Conflicts of Interest
   – Voting board members may not be a legislator, hold any state elective
     office, or be a state or municipal employee
   – Voting members may not be in any way affiliated with a health insurer,
     including an employee, consultant or board member of a health insurer,
     having an ownership interest in a health insurer, or otherwise
     representing a health insurer
  State Legislation Example 2: “Oregon
 Health Insurance Exchange Corporation”

• Entity, Governance
   – Quasi Governmental Agency/Free Standing Public Corporation
   – Board of 9 – 7 voting & 2 ex officio nonvoting
   – Governor appoints voting members, subject to senate confirmation
   – Governor will appoint initial board chair & vice chair to serve 2 years
   – Governor may appoint an initial interim executive director of the
     corporation; otherwise the board appoints the executive director
   – The board must establish an Individual and Employer Consumer Advisory
     Committee for ongoing stakeholder input
   – The board may establish other advisory and technical committees

• Conflicts of Interest
   – At least 2 voting members must be consumer members who purchase a
     qualified plan through the Exchange – one individual and one small

  State Legislation Example 2: “Oregon
 Health Insurance Exchange Corporation”

• Conflicts of Interest
   – No more than 2 voting board members may be:
        • Employed by, consultants or board members of an insurer or third party
          administrator, an insurance producer, a health care provide, health care
          facility or health clinic
        • Members, board members or employees of a trade association of insurers,
          third party administrators, health care provider, health care facility or health
        • Health care providers, unless they receive no compensation for rendering
          services as providers and do not have ownership interests in professional
          health care practices

   – If a board member has a conflict of interest on an issue before the
     board, the member must declare the conflict of interest and it is
     recorded. The member may participate in discussions but not vote.

     State Legislation Example 3: West
     Virginia Health Benefit Exchange
• Entity, Governance
   – Quasi-governmental agency/Administratively housed in or supervised by
     a state agency
   – Board of 10: 4 voting ex officio members - Commissioner, Commissioner
     of WV Bureau for Medical Services, Director of WV CHIP, and the Chair
     of WV Health Care Authority
   – 4 representing interests of: individual health care consumers, small
     employers, organized labor, and insurance producers
   – 1 representing payers, 1 representing providers
   – Payer and Provider representatives selected by Chair of Board, other
     appointed by Governor including Chair of Board with advice and consent
     of Senate
   – Appointed members serve 2-year term, eligible for re-appointment

• Conflicts of Interest
   – Payer representative selected by majority vote of an advisory group of
     representatives of the 10 carriers with the highest health insurance
     premium volume in state in preceding calendar year
   – By 2014, payer representative may not be an employee of a carrier or an
     affiliate of a carrier offering qualified plans on the exchange
         Other Approaches
o A few interesting legislation approaches from
  other states


• Legislative Health Issues Task Force

• Next Steps and Wrap-Up

• Website:



To top