Knowl­edge meetup

HHS of­fers guid­ance for in­surance ex­changes

Modern Healthcare - - The Week In Healthcare - Jes­sica Zig­mond

Soon af­ter a fed­eral judge in Vir­ginia ruled a key pro­vi­sion of the Pa­tient Pro­tec­tion and Af­ford­able Care Act un­con­sti­tu­tional last week, more than 150 of­fi­cials from 44 states met with HHS rep­re­sen­ta­tives to learn more about es­tab­lish­ing one of law’s key pro­vi­sions: health in­surance ex­changes.

HHS hosted the closed-door, two-day meet­ing in Washington for re­cip­i­ents of fed­eral plan­ning grants to im­ple­ment the in­surance ex­changes that states are re­quired to have in place by 2014. The meet­ing in­cluded break­out ses­sions for state of­fi­cials to re­ceive guid­ance from HHS and also learn from one an­other, ac­cord­ing to Nor­man Thurston, the health pol­icy and re­form ini­tia­tives co­or­di­na­tor in Utah Gov. Gary Her­bert’s of­fice. Thurston, who at­tended the meet­ing, said HHS’ agenda in­cluded topics on in­for­ma­tion technology, stake­holder con­sul­ta­tion, gov­er­nance, leg­isla­tive ac­tion, back­ground re­search and fi­nances.

In all, 48 states re­ceived $1 mil­lion each for plan­ning grants. Ap­pli­ca­tions for “build­ing” grants—funds for states ready to es­tab­lish ex­changes now—are due Dec. 22, Thurston said.

While stake­hold­ers were meet­ing in Washington, the Na­tional As­so­ci­a­tion of In­surance Com­mis­sion­ers on Dec. 16 adopted the Amer­i­can Health Ben­e­fit Ex­change Model Act, a law for states to con­sider when they in­tro­duce leg­is­la­tion to de­velop their own ex­changes.

“Many states will move Med­i­caid pro­grams onto the ex­change in ad­di­tion to pri­vate prod­ucts,” said Illi­nois In­surance Di­rec­tor Michael McRaith, who chaired the sub­com­mit­tee to draft the act, which he said was a col­lec­tive ef­fort of more than 30 states. “An ex­change re­quires a statewide ef­fort. An ex­change is not en­deavor that can be taken with­out leg­isla­tive in­volve­ment and will re­quire the de­ci­sions that will be de­cided by pol­i­cy­mak­ers.”

McRaith said states could learn from one an­other about which ideas are good and which should be dis­re­garded.

“Al­low­ing flex­i­bil­ity, al­low­ing them to make de­ci­sions that are re­flec­tive of the state’s in­surance mar­ket, health­care econ­omy, provider com­mu­nity, is es­sen­tial to the health of the ex­change,” McRaith said. “ Then as we move for­ward fol­low­ing im­ple­men­ta­tion, states will learn from one an­other. We’ll learn what has worked in one state and what hasn’t.”

McRaith also said nei­ther of the two in­surance ex­changes that have been es­tab­lished—in Utah and in Mas­sachusetts—is “the magic for­mula or recipe” for any other state be­cause the mar­kets in each state look so dif­fer­ent. Rather, states can learn from those ex­ist­ing struc­tures.

And Utah wel­comes that kind of learn­ing and di­a­logue, ac­cord­ing to Thurston. He said many rep­re­sen­ta­tives at the meet­ing last week were ea­ger to learn more about what Utah has done since it es­tab­lished its ex­change in 2009.

“Our first ad­vice is to call us,” Thurston said. “We have learned a lot. We’ve al­ready learned about what you re­ally need in place for this to work well,” he said, adding that this in­cludes a solid in­ter­face for con­sumers to use; good technology to work with in­surance com­pa­nies on both pric­ing and ap­pli­ca­tion is­sues; and an ef­fec­tive sys­tem to track the sta­tus of ex­change users. “You re­ally have to think through the daily needs and the re­la­tion­ships in­volved in ex­e­cut­ing this new type of pro­gram,” Thurston said.

The Utah Health Ex­change is over­seen by the state and is man­aged by two em­ploy­ees.

“Our ex­change was de­vel­oped pri­mar­ily to sup­port the de­fined con­tri­bu­tion mar­ket,” said John Nielsen, Her­bert’s health re­form ad­viser. “We found the small busi­ness com­mu­nity was re­ally suf­fer­ing. Many small busi­nesses were fail­ing to of­fer health in­surance to em­ploy­ees,” he said. He added that the of­fice wanted to de­velop an al­ter­na­tive that would al­low em­ploy­ers to of­fer mon­e­tary as­sis­tance so em­ploy­ees could pur­chase in­surance.

Nielsen said he hopes that as the state moves for­ward to be­come fully com­pli­ant with fed­eral re­quire­ments by 2013, HHS will con­tinue to en­cour­age flex­i­bil­ity among the states.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.