State Network Tools for Insurance Regulators. NAIC Summer 2012 National Meeting August 12, 2012 Atlanta, GA
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1 State Network Tools for Insurance Regulators NAIC Summer 2012 National Meeting August 12, 2012 Atlanta, GA
2 Heather Howard Director, State Health Reform Assistance Network Lecturer in Public Affairs, Princeton University s Woodrow Wilson School of Public and International Affairs Former Commissioner, New Jersey Department of Health and Senior Services Mila Kofman Research Professor, Georgetown University Health Policy Institute State Network Technical Expert Former Maine Superintendent of Insurance
3 Agenda Overview of the State Network Tools for Departments of Insurance
4 State Health Reform Assistance Network RWJF-funded program providing technical assistance to states to maximize coverage expansions under ACA Theory of Change: focus on a diverse group of 10 states to develop successful implementation models and share lessons learned Technical Assistance Strategies: Multi-disciplinary team providing operational level technical assistance Meet each state where they are Deploy a team of technical experts outside state procurement Facilitate peer-to-peer learning Inform Federal policymaking
5 Diverse Group of States Alabama Colorado Maryland Michigan Minnesota New Mexico New York Oregon Rhode Island Virginia
6 Focus on ACA Coverage Expansion Health Insurance Exchange Medicaid Expansion Coverage Eligibility and Enrollment Simplification Insurance Market Reforms
7 Examples of Technical Assistance Regulatory analyses of proposed rules on Exchange Implementation & Reinsurance, Risk Corridors, and Risk Adjustment Timelines and work plans Issue briefs on linking Medicaid and Exchanges Webinars on Basic Health Program option, Essential Health Benefits, Review of microsimulation models, Native Americans and Health Reform MOU s between state agencies
8
9 State Network: Assistance for State Regulators Health Insurance and Managed Care (B) Committee NAIC August 12, 2012 Mila Kofman, J.D., Research Professor and Project Director Cell: Direct: Georgetown University Health Policy Institute,
10 Team at Georgetown University FOCUS Implementation of private health insurance market reforms Implementation of Individual and SHOP Marketplace Exchanges TEAM: Mila Kofman, Sally McCarty, Katie Dunton, & Max Farris Former state insurance regulators implementing ACA & HIPAA Former federal regulators implementing ACA & HIPAA Georgetown University Health Policy Institute,
11 State Network Focus Implementation assistance Menu of options within the ACA to fit different markets, goals, and visions Driven by requests from states (governors, exchanges, insurance regulators) Experts with on-the-ground experience (former insurance commissioners and regulators, former MA Connector CEO and COO, former federal regulators) Georgetown University Health Policy Institute,
12 Tools Can Be Used By All States Self-audit checklist (attached) Compare existing insurance laws to the ACA s minimum requirements for private health insurance Identify inconsistency and areas for legislative or regulatory changes Georgetown University Health Policy Institute,
13 Strategic Planning Assess resource needs Facilitate/lead in-state planning sessions Draft work-plans (high-level to ensure that nothing falls through the cracks) Essential Health Benefits Planning Template (attached) Georgetown University Health Policy Institute,
14 Exchange Functions and Inter-agency Responsibilities and MOUs Exchange Functions Checklist (attached) To leverage existing state agencies expertise (exchange functions) To help identify and document functions currently performed and to determine which agencies/entities could perform such functions going forward To help determine overlap among agencies To ensure that none of the essential functions that an exchange must perform fall through the cracks Checklist can be used as a basis for agreements/mous among agencies and between exchange and agencies as required. Georgetown University Health Policy Institute,
15 Form Review Checklists Checklists for non-grandfathered 2014 products: individual market outside the exchange (attached); individual market inside & outside the exchange; small group market outside the SHOP exchange; small group market inside & outside the SHOP exchange; and EHB package for 2014 individual and small group market products. Georgetown University Health Policy Institute,
16 Other Tools Cheat sheets Requirements for certified qualified health plans External review requirements Effective rate review In the pipeline and future products will share with all states Georgetown University Health Policy Institute,
17 Heather Howard Questions? Mila Kofman
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