Office of Consumer Information and Insurance Oversight. State Planning and Establishment Grants for the Affordable Care Act s Exchanges

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1 Office of Consumer Information and Insurance Oversight State Planning and Establishment Grants for the Affordable Care Act s Exchanges Reporting Templates Quarterly Project Reports Date: State: Iowa Project Title: Iowa State Planning and Establishment Grant for the Affordable Care Project Quarter Reporting Period: Quarter 1 (09/30/ /31/2010) Grant Contact Information Primary Contact Name: Julie McMahon Primary Contact Number: (515) Primary Contact Address: jmcmahon@idph.state.ia.us Secondary Contact Name: Angie Doyle Scar Secondary Contact Number: (515) Secondary Contact Address: adoyle@idph.state.ia.us Website (if applicable): Award (Grant) Number: HBEIE Date submitted: 8/25/10 Project Summary The following provides a summary of the progress made in each core area for the Iowa State Planning and Establishment Grant for the Affordable Care. Core Areas Background Research Iowa s background research is being gathered from a wide range of sources. In order to form an accurate assessment of Iowa s insured and uninsured population, staff are reviewing existing data including census data and data from Medicaid, CHIP, and the IowaCare programs. To determine insurance cost and coverage impacts on Iowans, staff are examining a 2008 report entitled Cost and Coverage Impact of Options for Expanding Health Insurance Coverage in Iowa. This report is based on a study conducted by the Lewin Group at the commission of the Iowa General Assembly. Iowa s Insurance Division (IID) is also reviewing filings for premium

2 rates and conducting surveys of carrier and market provider competiveness and carriers benefit designs. An additional source of information includes collecting background information from a 2010 Iowa Employer Benefits Study. This study was conducted by David Lind, a well respected expert in Iowa on healthcare costs. The Lind report estimates that in Iowa, family coverage will rise significantly by 2020 and the cost for family coverage will range from $34, $44,895. Stakeholder Involvement Iowa has spent a significant amount of time this quarter in engaging stakeholders and the public. Five regional meetings and five focus groups took place across the state. To ensure the meetings were well attended, announcements were made by local media and through electronic venues such as list serves and s. Joel Ario was the introduction speaker of the first regional meeting in Des Moines. Additional speakers included the former Director of Public Health, the Medicaid Director, and the Insurance Commissioner. Each speaker provided background and educational information of the Health Benefits Exchange and discussed the roles of their perspective agencies within the Exchange. The presentations were professionally videotaped and several were shown at other meetings. These presentations can be accessed at: Because stakeholder feedback is considered essential, a large part of each of the meetings was dedicated to participant comments and questions. Each meeting was very well attended by community stakeholders such as consumers, providers, insurance agents, business owners, policymakers and other interest areas. Five focus groups were also conducted across the state. Focus group participants were invited to represent consumers that may be part of the first pool of Iowans to use the Health Benefits Exchange. Demographics of the participants were collected and a questionnaire script was created to assure consistency of the information gathered. Two additional focus groups are being planned that will target population groups not sufficiently represented in the initial focus groups. A final report will be drafted that will compile all focus groups results. This report will be shared with the HBE advisory council, policymakers, stakeholders and consumers. Iowa is additionally creating an advisory council that will represent the interest and consumer groups. The advisory council will make final recommendations of the HBE. Members are being appointed by the Directors of the interagency workgroup departments. A list of potential council stakeholders has been compiled and invitations are being drafted. Educational materials used in the regional meetings and focus were created to use for outreach purposes. Educational material was used at focus groups and regional meeting and will be used for future stakeholder engagement. This material can be assessed on Iowa s HBE website: Program Integration The interagency workgroup continues to meet on a regular basis. IDPH is leading the facilitation of this workgroup. IID is currently determining how a Health Benefits Exchange can be 2

3 integrated in the existing insurance information exchange. The Department of Human Services (DHS) has contracted with FOX to provide consulting services. FOX will evaluate business processes and IT solutions that will integrate Medicaid and CHIP eligibility determinations, enrollment, and covered services into the HBE. FOX will also assess the tax credit eligibility procedures. Additionally, FOX will assess the current infrastructure to identify IT requirements, system development needs for program interoperability, and what is necessary for seamless enrollment into coverage plans. FOX will develop an options analysis, cost benefit analysis, and issue an RFI in the spring of Also, The Iowa Department of Revenue is studying tax credits and subsidies to determine whether they can be integrated into the HBE. Resources & Capabilities Two members of the Interagency Workgroup attended the OCIIO Exchange Planning Grantee Meeting in Arlington, Virginia on December 16 th and 17 th. This was very helpful in determining the resources and capability needs that Iowa will need. Members of the Interagency Workgroup continually participate in education webinar and the Exchangers listserv to guide us in determining these needs. Iowa is contracting with organizations for the development of a strategic plan for eligibility integration in the exchange and for an Iowa insurance market assessment. Governance The Legislative Health Care Coverage Commission was created by 2009 Iowa Acts, Chapter 118, 1 (SF 389). The Commission is charged with developing an Iowa health care reform strategic plan that includes a review, analysis, and prioritization of the HBE. In December, the Commission finalized their recommendations for Iowa s current legislative session. The recommendations are as follows: The Insurance Information Exchange shall be located in a new or existing State agency, or a quasi-governmental agency with an advisory board. The advisory board shall consist of individuals representing carriers, providers, agents/brokers and the public. At such time as a governing board is established for the 2014 Iowa Health Benefit Purchasing Exchange, that governing board should replace and assume the duties of the advisory board of the Iowa Insurance Information Exchange. The Iowa Health Care Coverage Commission shall serve as the Iowa Insurance Information Exchange Advisory Board in order to fulfill its statutory duties as specified in S.F (Iowa Code ). Finance Iowa s interagency workgroup is currently waiting for guidance from the Governor and legislature to direct the implementation of the HBE. Direction from the Governor s office and the legislature is expected to occur during this current legislative session. Planning for implementation can occur once direction is received. 3

4 Interagency agreement forms have been finalized and signed by the Iowa Department of Public Health and the three contract agencies- Iowa Department of Human Services, Iowa Insurance Division, and Iowa Department of Revenue. Due to administrative changes, hiring of staff has been delayed and contract amounts have shifted. These forms include updated budgets for the contract agencies. Technical Infrastructure As mentioned above, the Department of Human Services (DHS) has contracted with FOX: A Cognosante Company (FOX), to provide consulting services. FOX will evaluate business processes and IT solutions that will integrate Medicaid and CHIP eligibility determination, enrollment, and covered services into the HBE. Additionally, FOX will assess the current infrastructure to identify IT requirements, system development needs for program interoperability, and what is necessary for seamless enrollment into coverage plans. FOX will develop an options analysis, cost benefit analysis, and issue an RFI in the spring of A press release describing the company is located here: FOX s website is located here: Business Operations Interagency agreement forms have been signed between the Iowa Department of Public Health and three contract agencies including the Iowa Department of Human Services, the Iowa Insurance Division, and the Iowa Department of Revenue. The interagency agreements outline the HBE planning and development duties of each agency under the Iowa State Planning and Establishment Grant for the Affordable Care Act s Exchanges. To facilitate these duties, the agencies have formed an Interagency Workgroup that meets bi-weekly. Additionally, and as mentioned above, Iowa has contracted with FOX to provide business process consulting services. Regulatory or Policy Actions Refer to the Governance section above for information about the Legislative Health Care Commission. Additional policy recommendations made by the Commission pertaining to the Health Benefits Exchange include: Iowa should take all necessary action to maximize its opportunities to administer its own health care markets by committing resources to the processes necessary to establish a 2014 Iowa Health Benefit Purchasing Exchange. Iowa should take action in 2011 to promote the establishment of a 2014 Iowa Health Benefit Purchasing Exchange. The legislature should take action during the 2011legislative session to establish an independent entity to guide the planning, development, and eventual governance of a 2014 Iowa Health Benefit Purchasing Exchange. The Iowa Insurance Information Exchange shall be designed and operated to ensure the most seamless transition possible to a 2014 Iowa Health Benefit Purchasing Exchange within the dates prescribed by the PPACA. 4

5 For the full list of recommendations made by the council, please visit Barriers, Lessons Learned, and Recommendations to the Program As mentioned in the Stakeholder section, one barrier that is currently being addressed is ensuring that focus group participants are a true representation of Iowa s population. Additional focus groups are being scheduled to address this barrier. Due to changes in Iowa s state administration, filling staffing needs has also been a barrier. In addition, a key staff person for the planning grant accepted a position outside of IDPH. Staff has been shifted to fill the requirements of this grant. Iowa s political landscape has also significantly changed after the last election. The interagency team is waiting for guidance from the Governor and legislature to direct the implementation of the HBE. Technical Assistance Iowa does not foresee any specific technical assistance needs at this time. However, any feedback or direction from other states regarding barriers and successes would be helpful. Draft Exchange Budget At this time, IDPH is not ready to put forth any budget for the next four years due to the changes in the administration of the department, the new Governor, and significant changes in the legislators. As previously stated, the interagency team is waiting for guidance from the Governor and legislature to direct the implementation of the HBE. Designing a budget and workplan at this time would be premature and could be counterproductive in planning for the HBE. Direction from the Governor s office and the legislature is expected to occur during this current legislative session (and in the second quarter of the grant). Planning for implementation will occur immediately following receipt of this direction and a draft exchange budget will be submitted. Work Plan Attached is Iowa s workplan that was submitted with the original grant application. Iowa will sustain this workplan according to the requested procedures documented in the template by OCIIO. Background Research Name of milestone: Compiling background information Timing: Ongoing Description: Conducting environmental scan of existing available data. Information pertaining to information sources is available at the beginning of the grant under Background Research. Name of milestone: Public Program inoperability Timing: Currently being conducted Description: The Department of Human Services has entered in a contract with Fox consulting firm to develop a strategic plan for eligibility integration of Medicaid and the HBE. 5

6 Milestone 3 Name of milestone: Insurance Market Analysis Timing: Currently being conducted Description: Iowa s Insurance Division is conducting a health insurance market analysis that includes reviewing filings for premium rates and conducting a survey of carriers benefit designs and surveying carrier and provider market Stakeholder Involvement Name of milestone: Regional Meetings Timing: December to January Description: Five regional meeting occurred across the state to engage the public and stakeholders. Presentations were given and educational material was disseminated. A large portion of the meetings were reserved for questions and comments. Name of milestone: Focus Groups Timing: December to February Description: Five focus groups have taken place across the state. The focus groups were focused conversations with members of the community that represented Iowa s healthcare consumer. Two follow up focus groups will occur to focusing on populations that were missing in the demographics. Milestone 3 Name of milestone: Stakeholder Advisory Council Timing: Ongoing Description: Members have been selected for the Stakeholder Advisory Council that will make final recommendations to the Governor and legislature. Letters are being sent out to members and initial meeting is being planned. Program Integration Name of milestone: Interagency Workgroup Meetings Timing: Ongoing Description: Regular meetings are taking place between IDPH, DHS, IID, and IRD to assure integration between programs. Name of milestone: DHS contract with Fox Consulting Timing: January March Description: DHS has entered in a contract with Fox consulting to develop a strategic plan for public health program eligibility integration in the Health Benefits Exchange. A RFI should be ready to be released this March. 6

7 Resources & Capabilities Name of milestone: Attending the OCIIO Exchange Planning Grantee Meeting Timing: December 16 th through 17 th, 2010 Description: The Grantee Meeting was very helpful in determining the resources and capability needs that Iowa will need. Name of milestone: DHS FOX Contract and IID Market Analysis Contract Timing: Currently in progress Description: Iowa is contracting with organizations for the development of a strategic plan for eligibility integration in the exchange and for an Iowa insurance market assessment. Governance Name of milestone: Legislative Health Care Coverage Commission Timing: December 2010 Description: The Legislative Health Care Coverage Commission made their final recommendations for the current legislative session. One of the recommendations included a recommendation on the governance structure for the current Health Information Exchange that would eventually be replaced by the HBE. Finance Name of milestone: Signed Interagency Agreement Forms Timing: Completed January 14, 2011 Description: Interagency agreement forms that have been signed by the Iowa Department of Public Health and the three contract agencies. Due to administrative changes, hiring of staff has been delayed and contract amounts have shifted. These forms include updated budgets for the contract agencies. Name of milestone: Anticipating guidance from the Governor and legislature Timing: Currently occurring Description: Direction from the Governor s office and the legislature is expected to occur during this current legislative session. Planning for implementation can occur once direction is received. Technical Infrastructure Name of milestone: DHS contract with Fox Consulting Timing: January March Description: DHS has entered in a contract with Fox consulting to develop a strategic plan for public health program eligibility integration in the Health Benefits Exchange. A RFI should be ready to be released this March. 7

8 Name of milestone: Insurance Market Analysis Timing: Currently being conducted Description: Iowa s Insurance Division is conducting a health insurance market analysis that includes reviewing filings for premium rates and conducting a survey of carriers benefit designs and surveying carrier and provider market Business Operations Name of milestone: Signed Interagency Agreement Forms Timing: Completed January 14, 2011 Description: Interagency agreement forms that have been signed by the Iowa Department of Public Health and the three contract agencies to outline what each agency will comply with during the Iowa State Planning and Establishment Grant for the Affordable Care Act s Exchanges. Name of milestone: DHS contract with Fox Consulting Timing: January March Description: DHS has entered in a contract with Fox consulting to develop a strategic plan for public health program eligibility integration in the Health Benefits Exchange. A RFI should be ready to be released this March. Regulatory or Policy Actions Name of milestone: Iowa Legislative Session Timing: January 2011 May 2011 Description: Iowa s legislative session was convened in January. The results of the election that took place in the fall produced a switch in Governor and the house changed to a republican majority. The interagency workgroup looks forward to educating the new members about the HBE and receiving direction for implementation. Name of milestone: Legislative Health Care Coverage Commission Timing: December 2010 Description: The Legislative Health Care Coverage Commission made their final recommendations for the current legislative session. Many of their recommendations pertained to the development and implementation of the HBE. Collaborations/Partnerships Name of Partner: Iowa Department of Human Services Organizational Type of Partner: Interagency Workgroup Member (also the State Medicaid Agency) 8

9 Role of Partner in Establishing Insurance Exchange: The Iowa Department of Human Services (DHS) is a partner in Iowa s Interagency Workgroup to develop the initial plan for an insurance exchange in Iowa. DHS is responsible to lead the Interagency Planning Workgroup tasks around the strategic planning for eligibility integration of Medicaid, CHIP and tax credit subsidies in a state Health Benefit Exchange. Accomplishments of Partnership: 1. DHS staff participated in the planning, and attended all, of the regional meetings. Five state regional meetings were held in December 2010 and January (Objective 1.1, Milestone 6) 2. DHS staff completed a Medicaid Eligibility White Paper that is posted on both the Iowa Department of Public Health (IDPH) and DHS websites. It was developed to assist stakeholders in understanding the role of Medicaid eligibility in a state health benefit exchange. A copy of this white paper is attached. (Objective 1.1, Milestone 3) 3. Office space for new staff was located by the DHS. Staff and contractors have begun to inhabit the office space available, and there is room for additional staff working on Iowa s Exchange Planning Grant should the need arise. (Objective 1.1, ) 4. The DHS has assisted in the development and execution of an interagency agreement that lays the foundation for multiple departments to work together under Iowa s HBE Planning Grant. The agencies include the Department of Public Health, Department of Revenue, Iowa Insurance Division, and DHS. (Objective 1.1, ) 5. DHS has executed a contract and begun work with FOX to assist in strategic planning necessary for integration of Medicaid, CHIP and the tax credit subsidies in a Health Benefit Exchange. (Objective 1.1, Milestone 3) Name of Partner: FOX: A Cognosante Company (FOX) Organizational Type of Partner: Consultant Role of Partner in Establishing Insurance Exchange: The DHS has contracted with FOX to provide consulting services for the development of a strategic plan for eligibility integration of Medicaid and the Iowa Health Benefit Exchange (HBE). FOX will evaluate business processes and IT solutions that will integrate Medicaid and CHIP eligibility determination, enrollment and covered services into the HBE, along with eligibility procedures for the tax credits. FOX will identify IT requirements, system development needs for program interoperability, and seamless enrollment into coverage plans by assessing the current infrastructure. FOX will develop an options analysis, cost benefit analysis and issue an RFI in the spring of

10 Accomplishments of Partnership: FOX has delivered, to the DHS, a project charter, work breakdown structure, communication plan, risk management plan, quality management plan, and staffing management plan. FOX is on schedule to produce a RFI in the spring of Program Integration (Relates to Objective 1.3 in work plan submitted with application). FOX is analyzing the current eligibility IT systems and infrastructure for Medicaid. FOX will be conducting an as-is and to-be analysis. Specifically, FOX will analyze the Medicaid eligibility determination business As Is processes and develop a To Be roadmap as it relates to field operations, state Medicaid eligibility policy and the Iowa Automated Benefit Calculations (IABC) system to determine the impact on a new Medicaid eligibility determination processes and system as well as the impacts to the HBE to achieve a defined business outcome. 2. Resources and Capabilities (Relates to Objective 2.1 in work plan submitted with application). FOX is working on a strategic plan to identify business processes and IT solutions to integrate Medicaid, CHIP and tax credits eligibility determinations and enrollment. FOX will examine Medicaid eligibility determination system options that support and align with health care reform, create innovative business processes and utilize the most advanced technologies. 3. Technical Infrastructure (Relates to Objective 2.2 in work plan submitted with application). FOX is in the process of identifying needs for Medicaid program interoperability with the HBE. FOX is looking to tie Medicaid eligibility in the Iowa HBE by analyzing interfaces with other systems. Additional Stakeholder Partners A great deal of time has been spent on engaging stakeholders during the first quarter. The list below is not an exhaustive list but it does give a snapshot of those partners we have engaged thus far. Legislative Health Care Commission o Legislatively Created Commission to Work on HC reform o Makes Recommendations to Legislature concerning HC reform opportunities o Commission s sustainability Medical Home Advisory Council o Legislatively Created Health Care Reform Council o Advisory group that is working on creating a Medical Home system in Iowa. Prevention and Chronic Care Management Council o Legislatively Created Health Care Reform Council 10

11 o Advisory group that is working on strategies concerning preventing and managing chronic care in Iowa. Insurance Federation o Association of Insurance Providers in Iowa o Represents the interests of Insurance providers in Iowa o Transparency in planning process o Represents the interests of Insurance providers in Iowa Local Public Health Agencies o Provides Public Health Services on a community level o Questions about their role in the HBE and the larger HC reform efforts Organizations representing insurance brokers and agents o Provides broker services in purchasing insurance o Transparency in planning process o Questions about their role in the HBE Partnership for Better Health o Nonprofit Organization that promotes best practices in health o Promotes, educates and advocates better health practices Iowa Nebraska Primary Care Association o Association for Community Health Centers Direct Care Worker Association o Association representing direct care workers o This particular workforce has a large percentage of uninsured. Their concerns would represent the concerns of many consumers. Medical Provider Organizations o Various groups representing providers such as Medical Society and Physicians Association Society Mental Health Organizations o Various groups representing mental health providers and mental health advocacy groups. o Concerned over mental health being included in benefits packages and access to providers Iowa Nurse Association o Statewide Association representing nurses Iowa State Association of Counties 11

12 o Statewide Association representing the interests of Iowa s 99 counties Consumers and Consumer Advocacy Organizations o Representing interests of consumers o Transparency in planning process and solicitation of input o Concerns over usability of HBE and quality of products sold in the HBE 12