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Welcome & Minutes Approval
February 19th, 2015
Michele Eberle, MHBE Plan Management
Subi Muniasamay, CIO
A service of Maryland Health Benefit Exchange
2015 Open Enrollment Update
Michele Eberle, Director PPM
A service of Maryland Health Benefit Exchange
Call from CMS to allow individuals additional time to
complete enrollment based on overwhelming
response and impact to call centers and systems
All SBMs agreed to consider, all but three states —
Hawaii, Kentucky and Vermont — had announced
extensions by Monday afternoon
Maryland agreed to allow anyone who was unable to
complete their application by midnight on 2/15 until
2/28 to complete enrollment
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What the Website says
Open enrollment to buy a plan for 2015 ended Feb. 15, 2015.
However, Maryland Health Connection is allowing people to complete their enrollments until
Feb. 28, 2015. You need to have started an application at MarylandHealthConnection.gov or
have contacted the call center at 855-642-8572 by Sunday, Feb. 15, to be able to complete the
process by Feb. 28.
The online application will allow you to check a box to confirm you tried to enroll by the Feb. 15
deadline but were not successful, and you will be able to complete your enrollment by Feb. 28,
2015.
If you enroll in a qualified health plan by Feb. 18, your coverage begins March 1, 2015. If you
enroll in a QHP from Feb. 19 to Feb. 28, your coverage begins April 1, 2015. Enrollees would
not be subject to the federal tax penalty, which allows an exemption for three months without
coverage during the calendar year.
Enrollment continues year-round at MarylandHealthConnection.gov for people who are eligible
for Medicaid.
You may also be able buy a plan outside of open enrollment if you have special circumstances
such as having a baby, getting married or losing other health coverage.
Open enrollment for 2016 begins this fall.
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By the Numbers
269,062 enrolled through MarylandHealthConnection.gov
84,790 QHP with an APTC
– 32% total QHP and Medicaid enrollments
– 71% total QHP enrollments
34,986 QHP w/o an APTC
– 13% total QHP and Medicaid enrollments
– 29% total QHP enrollments
149,286 Medicaid enrollments
– 55% total
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IT Updates
Implementation Advisory Committee
Meeting
February 19, 2015
Presented by: Subramanian Muniasamy
CIO, MHBE
A service of Maryland Health Benefit Exchange
Agenda
 CIO Introduction
 IT Overview
 M & O Releases
 Planned Improvements
 Q&A
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CIO Introduction
Subramanian Muniasamy
Chief Information Officer
MD HBX Experience
•
Led and successfully delivered the MD HBX
Solution in 7 months as the key management
leader from Deloitte Consulting
•
Led the team to stabilize the Legacy MD HBX
system as the Director from Optum/QSSI
Joined MHBE on January 07, 2015
Executive summary
 17 years experience in designing and
building systems for Health and Human
Service programs like Medicaid, Cash,
SNAP and CHIP
 Technology and Management Leader,
having provided leadership on several
high profile large-scale IT programs for
State and Federal Government
Prior Positions
• Director, Optum/QSSI
• Senior Manager, Deloitte Consulting
Education
• MBA in Leadership
• Bachelor of Engineering in Electronics &
Communications
State & Federal Govt. Experience
•
Established an effective governance
operating model to manage the Federal
Facilitated Marketplace (FFM)
•
Led the Electronic Submission of Medical
Documents (ESMD) program for CMS
•
Led the Provider Enrollment Chain
Ownership System (PECOS) program for
CMS
•
Instrumental in the implementation of
integrated eligibility (MA, SNAP, Cash and
CHIP) solutions for the State of New
Hampshire (NH) and Commonwealth of
Pennsylvania (PA)
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IT Overview
Enhancements
M&O Releases
Complete
January
June
Planned
At Risk
Planning
February
Planning
Planning
Planning
Planning
Requirements
Requirements
Requirements
Requirements
Requirements
Design / Development
Design / Development
Design / Development
Design / Development
Testing
Design /
Development
Testing
Testing
Testing
Testing
Implementation
Implementation
Implementation
Implementation
Implementation
July
Functionality
Status
Planning
Requirements
Design / Development
Testing
Implementation
 Approximately 35% of base
applications, 20% of security and 20%
of FileNet components have been
installed in TRN
Legacy HIX Decommissioning
 Approximately 50% of the Dev/Test
servers have been powered off (65
of 129)
MHBE Network Upgrade
 Enhancement to the MHBE VPN,
active directory, telephone etc..
Planning
Requirements
Design / Development
Testing
August
September
Functionality
Status
 Renewal functionality reduces the
burden of manual renewal processing
and allows consumers to choose
whether to actively extend existing
coverage, change coverage, or be
auto-assigned a new
program/coverage group.
Lower Environment Migration
Special Projects
April
On-Track
 1095-A reporting functionality reduces
the burden of manual processing and
allows MD HBX to remain in
compliance with IRS reporting
standards.
Implementation
1095 & MA Database Transition
 Documentation supplied by QSSI and is
currently under review by Deloitte
 Table schema will be developed once review is
complete
QHP
34,986
13%
Enrollment Overview
Other Items
 Data Synchronization of Passive Renewals
Population ( ~ 5000 Individuals ) between
Carriers and HBX System
 Medicaid Redetermination will migrate ~ 1 million individuals into HBX system.
 Implement the Extension of open enrollment through 2/28 from 2/15
APTC
84,790 32%
Medicaid
149,286
55%
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M&O Releases
 January Release

Deployed into the production environment on: 1/21/2015

Contained 19 defect fixes

Key features include: 508 Compliance updates, language and tool tip
updates, and updated special enrollment business rules
 February Release

Scheduled for deployment on: 2/27/2015

Includes fixes to 20 defects

Key features include: 834 enrollment file updates, notice and verification
updates, update language preferences for brokers
 April Release

Scheduled for deployment on: 4/30/2015

Includes fixes to 15 defects

Key features include: disenrollment updates and notices, state income
verification interface, carrier template, SBC updates, and 2015 FPL update
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Planned Improvements
#
Enhancement Items
1
PARIS Interface
2
Auto Enrollment of Medicaid
Age-Out Population
3
Emergency Medicaid
4
ECMS/ FileNet Integration
5
CMS 834 Integration Readiness
6
Transitional Medicaid
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Dental Plans
8
Tobacco Ratings
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Removal of IDB
Regulatory
Requirement
PARIS – Public Assistance Reporting Information System
ECMS – Enterprise Content Management System
IDB – Interim Database
Operational
Efficiency
Business
Excellence
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Q & A
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2016 SERFF Template Changes
JP Cardenas, MHBE PPM
A service of Maryland Health Benefit Exchange
2016 SERFF Template Changes
Plans & Benefits Template – Plan Attributes
The fields HSA Eligible, HSA/HRA Employer Contribution, and HSA/HRA
Employer Contribution Amount have been moved from the Benefits Package
worksheet to the Cost Share Variances worksheet where they can now be
completed for each plan variation.
For SHOP Plans – Does this plan offer Composite Rating? Individual plans
will auto-populate “No”
Child Only Plan ID – no longer required for catastrophic plans
Disease Management Programs Offered (optional) – Weight Loss Programs
added as a new drop-down option for the 2016 plan year
EHB Percent of Total Premium (required) – for on-Marketplace plans
abortion services must be excluded from the EHB proportion. Used for
subsidy calculation
2016 SERFF Template Changes
Plans & Benefits Template – URLs
URL for Summary of Benefits & Coverage and Plan Brochure now moved to
the Cost Share Variances worksheet.
URL for Enrollment Payment (optional) – a link connecting the consumer to
a carrier’s payment portal. Please submit formal comment to
[email protected] describing interest in display.
2016 SERFF Template Changes
Plans & Benefits Template – General Information,
OOP Exceptions, SBC Scenario, Cost Sharing
Benefit Explanation (optional) – If edited an EHB variance reason is no
longer needed.
Subject to Deductible [Tier 1 and 2] – removed from Plan and Benefits
Template for the 2016 plan year. AVC will use actual copay and coinsurance
drop down values.
SBC Scenarios – the fields in this section are now required for QHPs
Maximum Out of Pocket and Deductibles – may now allow for per-group or
per-person distinctions, i.e. stacked deductibles
Cost-sharing fields – “Not Applicable” an option for all fields
2016 SERFF Template Changes
Prescription Drug Template – Drug Tier Type
and Tier Cost Sharing
New Drug Tier Types - “Specialty Drugs,” “Zero Cost Share Preventive
Drugs,” and “Medical Service Drugs”
- list simplified to eliminate “Only Select Generics” and “Only Select
Brands”
Pharmacy Cost Sharing Types Columns removed (G, K, O, and S on
Formulary Tiers sheet)
Copayment and Coinsurance options will align with options on the PBT
Copayment and Coinsurance now allowable up to two decimal places
Copayment and Coinsurance auto-restraints when selecting ZCS Preventive
Drugs and Medical Service Drugs
2016 Plan Certification Standards
Michele Eberle, Director PPM
A service of Maryland Health Benefit Exchange
2016 Proposed Plan Certification Standards
CMS released on 12/19/2014, a draft annual letter to FFM
carriers setting forth proposals for 2016 plan certification
standards.
CMS has not released the Final 2016 Letter to Issuers, nor finalized the
HHS Notice of Benefit and Payment Parameters for 2016.
Proposed 2016 standards for federal marketplace are substantially
similar to 2015 standards, and most of the recommendations for MHBE
2016 standards remain the same as last year.
MHBE will post its proposed certification standards for public comment for
seven days on its website.
Any changes in the final federal rules or public comment may
result in a change to the MHBE 2016 Plan Certification
Standards.
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Network Adequacy
Proposed 2016 Certification Standard (Substantially similar to 2015 federal standard except where noted in red)
MHBE Proposed Recommendation
(Substantially similar to 2015 MHBE
standard except where noted in red)
Plans must submit complete provider lists that
include all in‐network providers and facilities for
all plans for which QHP certification is submitted. The provider list should be current,
accurate, and complete, including information
regarding which providers are accepting new patients. Plans may also be required to provide the directory information on their website in a machine‐readable file and format specified by HHS.
Drug formulary Internet link provided by plans
must link directly to list of covered drugs without
requiring further navigation, and must include
tiering and cost‐sharing. The formulary drug list URL must be up‐to‐date, accurate, and complete.
MHBE should continue current requirements that plans submit provider lists to CRISP. The provider list should be current (at least twice a month), accurate, and complete. MHBE may also require the provision of directory information on issuer websites in a machine‐
readable file.
Drug formulary Internet link provided by plans must link directly to list of covered drugs without requiring further navigation, and must include tiering and cost‐sharing.
The formulary link must be up‐to‐date, accurate, and complete.
Network Adequacy
Proposed 2016 Certification Standard (Substantially similar to 2015 federal standard except where noted in red)
Issuers must create a drug exception process for standard situations (in contrast to exigent circumstances) by which an enrollee can request access to a drug not on the plan’s formulary. The issuer must notify the enrollee of its coverage decision no more than 72 hours after receipt of the exception request. Issuers must have an external review process conducted by an independent review organization for denied requests.
MHBE Proposed Recommendation
(Substantially similar to 2015 MHBE
standard except where noted in red)
Issuers must create a drug exception process for standard situations (in contrast to exigent circumstances) by which an enrollee can request access to a drug not on the plan’s formulary. The issuer must notify the enrollee of its coverage decision no more than 72 hours after receipt of the exception request. Issuers must have an external review process conducted by an independent review organization for denied requests.
Network Adequacy
Proposed 2016 Certification Standard (Substantially similar to 2015 federal standard except where noted in red)
Certain QHP issuers must comply with standards and requirements related to quality reporting through the implementation of the Quality Rating System (QRS) and the Enrollee Satisfaction Survey (ESS). HHS will implement the QRS and ESS system including setting standards and calculating scores and ratings. HHS is implementing these national quality reporting systems in a phased approach. For 2016, certain QHP issuers must attest that they have complied with the specific quality reporting and implementation requirements.
MHBE Proposed Recommendation
(Substantially similar to 2015 MHBE
standard except where noted in red)
Certain QHP issuers must comply with the
federal standards governing QRS and ESS Survey information.
Issuers are also required to continue to provide quality data and Race, Ethnicity, Language, Interpreter Need, and Cultural Competency (RELICC) data to the Maryland Health Care Commission (MHCC).
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By the Numbers
Presentation to MHBE Board of Trustees canceled due to
State closure on 2/17/15
MHBE to post ‘proposed standards’ for comment
Expect comment period to end 3/1/15
Waiting on CMS final rule to publish MHBE final standards
23
SHOP Update
Michele Eberle, Director PPM
A service of Maryland Health Benefit Exchange
Public Comments?
Next Meeting: March 5th, 2015
Comments: [email protected]