COLORADO S BENCHMARK PLAN

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1 COLORADO S BENCHMARK PLAN Mental Health Parity Public Outreach Efforts Underway Moe Keller Vice President of Public Policy & Strategic Initiatives Mental Health America of Colorado

2 Selecting a Benchmark Plan Public hearings MHAC comments with NAMI Division of insurance picked from nine suggested plans. Benchmark plan chosen; MHAC s first choice. Chronic Care Collaborative and Colorado Consumer Health Initiative non profit groups worked together to choose a common preferred benchmark plan from their memberships.

3 Stakeholders included: Denver Health hospital Denver Metro Chamber of Commerce County health departments Colorado Rural Development Council Higher education facilities Life and health insurance brokerages Benefits-risk managers of municipalities State Commissioner of Insurance Governor s Budget Office Qwest Communications- health and disability benefits Colorado Center on Law and Policy Labor unions Mental health providers Rose Community Foundation African American Health Center Disability advocates Nursing homes Colorado Hospital Association County governments Lockton Companies of Colorado Colorado Association of Commerce and Industry Centura Health Association of Family Physicians

4 Colorado s Essential Health Benefits Benchmark Plans Options

5 MENTAL HEALTH PARITY 1997 Six biologically based mental illness in the small group and large group markets Expanded parity to include PTSD, eating disorders, specific anxiety disorders and substance use disorders. Large group market only Mental Health Parity and Addiction Equality Act passes ACA passes; includes the MHPAE

6 Kaiser Small Group Plan Colorado chose the Kaiser small group plan for the exchange. Included mental health parity for schizophrenia, schizo-affective disorder, bi polar, anxiety disorder, panic attacks and clinical depression. Did not include a second mental health/substance use disorder mandate.

7 CONFORMITY How to align Colorado s two state parity mandates with the ACA? Colorado Division of Insurance harmonization bill: Both state mental health parity bills will apply to the individual and small group markets The director of the division of insurance will have rule making authority for further conforming language to comply with the ACA.

8 Grants For Health Benefit Exchange Governor s Office received a one year, one million dollar grant from the Health and Human Services Department for planning the exchange. A Level One Grant from HHS for $17.9 M was awarded in Dec for one year. (ends in Oct.) Planning, staff, consultants, technical assistance, identify IT and computer issues and develop a three year business plan. Received a second Level One grant of $43Million to continue. Application for first Level Two grant underway. Open for business on October, 2013.

9 Advisory Subgroups Individual Experience Work Group Defines the role of navigators, the operation of the call center, how to handle appeals, how to notify customers of change of insurance status. Small Employer Work Group Defines policies and business procedures for small businesses to shop, compare and purchase on line.

10 Advisory Subgroups Outreach and Communications Work Group Defines how to educate consumers about the value of health insurance, what COHBE is and what the exchange offers. Health Plan Data and Technology Work Group Studies long term collection needs and metrics used to evaluate the success of the exchanges.

11 Guiding Principles for the Colorado Health Benefit Exchange Navigator Program 1) Navigators are responsible to consumers. 2) Navigators are experts in health insurance. 3) Navigators are accessible. 4) Navigators are appropriately trained and certified. 5) Navigators are culturally representative of and responsive to all Coloradans. 6) The Navigator program is structured in a way that is sustainable and builds off existing consumer assistance capacity in Colorado. 7) Navigators are accountable and held to high standards

12 CUSTOMER SERVICE CENTER Provides trained representatives for online chat and call in support. Trained to: Effectively transfer customers, when appropriate, between assistance sites or certified and licensed brokers. Navigators and on site assistance operators combine into one program: Health Guides.

13 CONNECT FOR HEALTH COLORADO Establishing the Connect for Health Colorado Assistance Network Community based organizations that will provide impartial assistance to consumers seeking health coverage through the individual and small group marketplace ( chambers, unions, counties, trades) Regional Hubs Grants available: housed in the exchange, funding from the exchange and private foundations

14 ASSISTANCE SITES Houses a local Health Coverage Guide. Conducts outreach within their area. Provides help with the process of shopping for health coverage through the marketplace. Help with applying for new financial assistance to pay for a private plan. Helps with accessing determination of eligibility for Medicaid and CHP+. Help with shopping without financial assistance.

15 COMMUNITY FORUMS Please join Aurora Health Access for a Community Forum about the Colorado Health Benefit Exchange. Connect for Health Assistance Network. When: Wednesday, March 13 from 8:30 10:30 (Light breakfast and refreshments will be provided.) Where: The Littleton Room at the Arapahoe County Department of Human Services E Alameda Dr., Aurora Special Guest: Adela Flores-Brennan, Assistance Network Manager at the Colorado Health Benefit Exchange During this meeting Ms. Flores-Brennan will provide an overview of the Connect for Health Assistance Network and the recently released Funding Opportunity Announcement. Details about the Funding Opportunity can be found on the Exchange website. Applications for grants are due April 8, Questions? Contact Maya Wheeler, Aurora Health Access, at [email protected]

16 Regional Hubs Responsibilities: Public education Outreach Information sharing Referral on regional level Mentoring Assistance sites Collaboration of sites and alliances within the area Grants available to interested agencies

17 NEW FEDERAL RULES Health insurance plans may offer four tiers of coverage: bronze, silver, gold platinum. Bronze: individual pays up to 40% of premium costs. Platinum: individual pays 10% of premium costs. Small group market: deductable no more than $2000. Small group market: deductable no more than $4000. per family.

18 Federal Rules No uniform national standard of coverage. States can set their own specific requirements. Enforcing standards is a state responsibility. Federal government will step in if it is felt the state is not enforcing insurance standards of coverage.

19 CONCERNS Not ready to start in October: computer glitches, not enough navigators for 300,000 expected enrollees. Public outreach/explanations not sufficient. Plans so rich in benefits that premiums too high. Deadline for carriers to file products and costs is May 1, Colorado has already placed in statute many of the huge cost drivers: mental health mandates, underwriting prohibitions, zero copays for preventative coverage, and gender prohibitions. Also, Colorado chose the Kaiser plan. This should keep possible higher rates lower than many other states.

20 Concerns Penalties for not enrolling too small; less than premiums. Sustainable funding of the Exchange: HB 1245 Funding Mechanisms for the Exchange. Special fees assessed against carriers. Not to exceed $1.80/per month. Gifts, grants and donations.

21 MORE DETAILED INFORMATION