This week, CMS reported how many persons have currently taken advantage of the tax season Special Enrollment Period (SEP) to sign up for coverage since the close of Open Enrollment on February 15. The current SEP, running from March 15 to April 30, has so far signed up 36,000 persons into coverage in states served by the Federally-facilitated Marketplace (FFM), with many State-based Marketplaces (SBM) keeping their own tally. The tax season SEP allows persons who did not have health coverage in 2014 and are subject to the individual mandate when they file their 2014 taxes to sign up for health coverage for 2015 in order to avoid having to pay a fee when they file their 2015 taxes.
Besides that, federal announcements were fairly quiet this week, though a few interesting documents were posted to CMS' Paperwork Reduction Act (PRA) site. One of the recent postings has information on the reports that Navigator entities for Open Enrollment 3 will have to submit to CMS. Departing from previous years, Navigator entities will have contracts for 36 months instead of the normal 12 months. Also, CMS has signaled that it intends to sign agreements with 102 entities across the 34 states served by the FFM, an increase from the 92 Navigator awardees in 2014. As always, State-based Marketplaces and Supported State-based Marketplaces will continue to run their own in-person assistance programs. Just a few days earlier, CMS posted a separate PRA with information on how insurers will submit provider network and formulary data in a machine readable format. The data, as required in the 2016 Notice of Benefit and Payment Parameters rule, will be submitted in a JSON file format which, according to CMS, "has quickly become the de facto standard for shuttling data across the internet, fueled primarily by the rise of mobile and APIs."
The final federal update comes from information recounted at Tuesday's board meeting for the New Mexico Health Insurance Exchange (NMHIX). At that meeting, NMHIX staff recounted their meeting with CMS, where NMHIX officials attempted to negotiate, among other issues, a financial arrangement for NMHIX to lease the use of the FFM online enrollment system to support enrollment in its Individual Marketplace. Currently, NMHIX uses HealthCare.gov to enroll individuals and families in Marketplace plans while running its own SHOP marketplace for small employers. At the meeting, according to NMHIX staff, CMS chose to defer entering into financial negotiations over a lease because the agency is anticipating the release of a proposed rule that would allow states to lease the FFM this fall, with a final rule expected in the spring of 2016. Until that final rule is released, according to NMHIX, it appears unlikely that Supported State-based Marketplaces will have to pay any of the user fees they collect to CMS for use of the FFM.
Moving into the states, things were quiet this week with few new developments or State-based Marketplace meetings. One of the reasons for the slow week may be because representatives from many of the SBMs were gathered in Denver, CO for a State Health Exchange Leadership Network meeting. A key focus of the meeting was for SBMs to share best practices and develop strategies to reduce costs, such as consolidating various back-office functions and pooling funds for certain development projects. According to a press release by the DC Health Benefit Exchange Authority, "As a result of state based exchanges interacting, participants will have a set of proposals that will be achievable in the short-term and produce savings, and action steps will build the foundation for further coordination and longer-term shared procurement."
Financial sustainability has emerged as a key focus for many SBMs this year, with financial considerations helping shape some policy decisions by Marketplaces. For example, at Tuesday's board meeting for the New Mexico Health Insurance Exchange (NMHIX), the board voted to stop building its individual marketplace technology, and instead continue to use the FFM. It was a difficult decision for some board members, who weighed the high costs and high risks of continuing to develop the NMHIX's IT platform against relying on the FFM with the final financial arrangement with CMS still undefined. After debating the issue, the board voted 8 to 4 in favor of relying on the FFM platform and asked staff to comment on the forthcoming proposed rule for states leasing the use of the FFM. Staff also reported at the meeting with updated SHOP enrollment numbers, showing the NM SHOP currently serving 877 covered lives and 147 employer groups. Later in the meeting, the board was presented with an outline of the Marketplace's marketing plan for SHOP and a recap of the results of NMHIX's outreach and marketing campaign for Open Enrollment 2. According to the presentation, NMHIX conducted mid-enrollment surveys and adjusted its marketing plan along the way, resulting in the awareness of BeWellNM increasing from 39 percent to 54 percent, with the majority of respondents, 67 percent, being driven to the BeWellNM website by TV, radio, and billboard advertisements. The presentation also included a brief timeline for NMHIX's carrier assessment.
Sticking with finances, this week lawmakers in Rhode Island held a hearing and heard public comment on Governor Gina Raimondo's (D) proposed assessment to fund the Marketplace. The assessment would levy a 3.8 percent fee on individual plans, and 1 percent fee on small group plans sold inside and outside of HealthSource RI.
Shifting coasts, budget proposals from both the House and Senate in Washington State have been released, with budgets varying from what was proposed by the Washington Health Benefit Exchange (WHBE). In its budget, the WHBE requested a US$147 million biennial budget. Overall, Governor Jay Inslee's (D) budget aligned with the WHBE's request, though it diverted US$20 million to the Washington State Department of Social and Health Services to assist with costs supporting Medicaid enrollment activities and lowered the WHBE's overall budget to US$127 million. However, lawmakers have introduced significantly different budgets, with the House releasing a budget of US$124 million, while the Senate has a US$85.9 million budget for the WHBE.
Also this week, the Department of Health and Human Services Office of the Inspector General (HHS OIG) released its audit of Maryland's allocation of shared costs between the Maryland Health Benefit Exchange and Maryland's Medicaid program. The report concluded that the state misallocated US$28.4 million in establishment grant funding for SFYs 2013 and 2014 because it used outdated estimated enrollment data and a cost allocation methodology with a material defect to apportion costs. Specifically, the state agency "did not recalculate and adjust its cost allocation prospectively by using the March 31, 2014 actual enrollment data," and instead used estimates from its contractor made during 2010 and 2012. In response, Maryland's Medicaid agency, the Department of Health and Mental Hygiene, wrote that it disagreed with the HHS OIG's findings because first, it had complied with CMS guidance on the frequency of cost allocation updates, and second, the OIG used a fiscal year rather than a calendar year when comparing its findings against the projections used by the Maryland exchange's consultant.
Finally this week, the Connect for Health Colorado Board of Directors announced on Wednesday that they had selected Robert C. Malone as a finalist to be the Marketplace's permanent CEO. According to the press release from the Colorado Marketplace, Mr. Malone has nearly 30 years of experience "across the insurance, brokerage, claims and cost containment industries" and was most recently the CEO of The Assist Group. A final decision on whether Mr. Malone will receive the position will likely have to wait, as current regulations require the Board to "post the name of the CEO finalist; allow the public to comment about the selection for 14 days; and obtain approval from the Legislative Health Benefit Exchange Implementation Review Committee before formally offering and hiring for the post”.
Dentons is the world's first polycentric global law firm. A top 20 firm on the Acritas 2015 Global Elite Brand Index, the Firm is committed to challenging the status quo in delivering consistent and uncompromising quality and value in new and inventive ways. Driven to provide clients a competitive edge, and connected to the communities where its clients want to do business, Dentons knows that understanding local cultures is crucial to successfully completing a deal, resolving a dispute or solving a business challenge. Now the world's largest law firm, Dentons' global team builds agile, tailored solutions to meet the local, national and global needs of private and public clients of any size in more than 125 locations serving 50-plus countries. www.dentons.com.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
