Plan Management Stakeholder Committee October 6, 2016

Welcome and Introductions

Standing Agenda

Meeting Minutes Approval

Feedback From the Field

Membership Changes

Open Enrollment Preparation

Issuer Renewal Notices, Billing Policies, Talking Points

• Issuer Renewal/Plan Exit Notice Copy: Due Thursday, October 13.

• Issuer Billing Policies, i.e. binder payment due dates vs

subsequent payments and internal grace periods (void status)

- Scope: MHBE Staff

- Due: Thursday, October 13

- Rationale: critical for interpreting MLRs/handling escalated

cases

• Issuer Talking Points for consumers inquiring about rate

increases/plan withdrawals, etc. related to renewals.

- Scope: MHBE Call Center

- Due: Thursday, October 13

- Rationale: consumers will receive consistent and customized

messaging from their issuers and MHBE on renewal questions

Responses due to: mhbe.carriers@Maryland.gov

Enrollment Events Coordination

• MHBE Sponsored Open Enrollment Events:

- College Enrollment Day: November 14 – 18

Issuers are invited to this event

- Library Enrollment Day: December 10

- “Extol & Enroll:” January 21 – 22

• Issuers must send products marketing POCs to

jenny.mancha@Maryland.gov for participation information and

coordination

• Connector Entity Sponsored Open Enrollment Events will occur

throughout Open Enrollment. Issuers seeking to participate in

these events must coordinate with Connector Entities directly.

- See the attached file for contact information.

MHBE Open Enrollment Call Center Hours

Plan Management Items

CAW Issuer Products Training Videos & Renewals Postcard Copy

• Videos: The due date for the videos has passed, issuers have

requested extensions for video delivery.

- Issuers that have been recorded by MHBE will receive copies of

their videos shortly.

• Postcard Copy: Mailed out to consumers by October 1.

- See the attached file for the copy

2017 Benchmark Plans

• For the purposes of the determination of the Premium Tax Credit

the following plans will serve as the benchmark plan:

• Rating Area 1: KP MD Silver 6000/30/Dental/Ped Dental

• Rating Area 2: KP MD Silver 2750/20%/HSA/Dental/Ped Dental

• Rating Area 3: Evergreen Health HMO Open-Access Silver HSA

2250

• Rating Area 4: KP MD Silver 2750/20%/HSA/Dental/Ped Dental

2018 Issuer Letter

• Preparations have begun for updating the issuer letter for 2018

• A draft issuer letter will be made available for comment in

November

American Sign Language Indicator

• MHBE has the ability to transmit an American Sign Language

indicator on the 834 to issuers.

• Per uniform standards, the language indicator on the 834 is “SGN”

Questions for written response:

What are issuer’s experiences with administering services to deaf

members with respect to outreach, etc. in other markets?

From a business operations perspective would receipt of this code

allow issuers to better serve their members? Is there a value-add?

Response: October 13 to mhbe.carriers@Maryland.gov

Mid-month APTC & Mid-Month Termination

• Mid-month APTC: MHBE will begin development of functionality

that allows for APTC proration.

• MHBE has the following questions for issuers to inform

development of this functionality:

- Rounding rules for mid-month APTC calculation

- How do carriers handle mid-month calculations now?

- How carrier is handling multiple APTC values and effective

dates from FFM.

- For the add transaction, the APTC for first part of the month and

rest of the month and APTC for next month shall be transmitted

to carrier through 834. We need to know how these 3 APTC

values and effective dates are calculated.

Should the 3 APTC values sent in a single 834 file or multiple

834 files?

Mid-month APTC & Mid-Month Termination (cont’d)

• MHBE has attached the draft functional requirements document to

this slide deck. Please provide insight/ask follow up questions

should there be gaps in logic.

• Due Date: October 20

• Response due to: mhbe.carriers@Maryland.gov

• Mid-Month Termination: MHBE will establish a uniform standard

with respect to voluntary terminations of a consumer’s enrollment.

Per 45 CFR 155.430(c)(3) and (d) a consumer may terminate an

entire contract with the issuer as soon as 14 days from the current

date and into the future – matching FFM functionality.

• Please respond to MHBE on the timeline required to begin

receiving and processing mid-month terminations appropriately.

• Due mhbe.carriers@Maryland.gov by October 20

Financial Assistance Issuer Orphan OutreachPlan

• Issuers may autorenew members without financial assistance in

cases where an 834-file for that member was not received.

• According to the timeframe described in the September PMSC

meeting, issuers are required to provide a report to MHBE that

details the affected members.

• Upon receipt of the report MHBE will outreach the affected

members through phone and paper notice to return to the HBX to

receive an eligibility determination and enroll.

• Members that do not take action after outreach by MHBE may

return to MHBE to receive their correct determination through the

escalated cases process.

Financial Assistance Issuer Orphan OutreachPlan

• Issuers must:

- Remove affected members from autodraft payment schedules

- Provide additional time for the affected members to pay the

appropriate premium

- If members should return as escalated cases, prioritize this

bucket and provide an additional indicator on the relevant

trackers

Plan Management Recap and Best Practices

SHOP Updates

SHOP Updates

• The SHOP Transition Plan has been completed

• Thanks to the Issuers, former SHOP Administrators, and

BenefitMall

SHOP Employee Eligibility and ElectionForm

• MHBE has met with CMS to discuss changes to the Employee

Eligibility and Election Form

• CMS provided feedback on which data fields are “necessary” for

eligibility and enrollment

• MHBE will follow up with CMS to receive sign-off on the revised

application

• MHBE will keep issuers updated until we receive complete sign-off

SHOP Welcome Letter and Employer ReferenceGuide

• Transitioning SHOP groups were provided with the attached

information:

Passive Renewals Batch Update

FD Batch Execution PlanDental and Health Changes

QHP Renewal FD Batch Execution:

Starting 09.26 QHO FD batch execution begins

QHP Renewal FD Batch Execution:

10.15.2016 Complete QHP renewals

Catch up Batches:

Process fixes for Carriers, and changes based on SEP adds for 2016

Open Enrollment:

Open Enrollment Continues through 1.31.2017

Run MA Renewals

10.8.2016 -10-9-2016

Open Enrollment:

Open Enrollment begins on 11.01.2016

DecemberNovemberOctoberSeptember

Terminations for Discrepancies:

Terminations run by 11.11.2016

Sun Mon Tue Wed Thur Fri Sat

September 28CF

29CF

30CF

Oct 1CF

2CF

3CF

4CF

5KP

6KP

7KP

8MA

9MA

10State Holiday

11Evegreen/ Cigna

12Dominion / Dentegra

13Fixes / Remaining Issues

14Fixes / Remaining Issues

15Fixes / Remaining Issues

FD Batch CalendarDental and Health Changes

FD Batch Current ResultsDental and Health as of 10/5/2016Changes

Carrier Processed Error Rate

CareFirst 47022 6.9% External* 0.2% Compliance 0.0% Invalid

Kaiser Permanente 0 n/a

Evergreen 0 n/a

Cigna 0 n/a

Dominion 0 n/a

Dentegra 0 n/a

*Of the 3275 External Errors, 3045 do not match SOR – ie, members whowere termed did not get excluded from the Renewals Run (batch timing)

Producer Authorization October 6, 2016

1. Authorized on an Individual basis only2. Application Received3. Reviewed for License, Exclusions, Debarments4. Required documents, training and system download sent to

producer5. Upon completion of requirements, producer is added to system and

authorization letter is sent6. Producer is obligated to contract with carriers and set up their

commission payments to either individual or assigned to an agency/company. This is also done through their chosen TPA.

Current Authorization Process

MHBE Authorized Producers

Producers have requested that agencies be authorized, instead of just individual producers, many times since the inception of Maryland Health Connection. There are some system limitations / adjustments that prevent us from doing this. However, Producer Operations would like to explore this action further and receive carrier feedback on the proposed changes.

Due to time constraints and system changes, any proposed changes to the Individual Marketplace authorization process would have to wait until the end of open enrollment 2017.

Proposed Changes

MHBE Authorized Producers

INDIVIDUAL MARKETPLACE

1. Authorizing Agencies or Companies can be done but our system is not set up to accommodate the names of an agency. However, an agency can appoint one producer to be the name in which the agency’s NPN would be put in the system under.

2. Consumers can search using the Agency Name and Zip Code to bring up that agency’s name

3. What would be sent to the carriers would be the name of the chosen producer and the agency’s NPN.

Proposed Changes

MHBE Authorized Producers

INDIVIDUAL MARKETPLACE

Adding Authorized Agencies to our HBX system without a producer’s name would require significant changes. It is not feasible at the present time for this system update to be completed. However, MHBE Producer Operations will work to add it to future releases.

Thus, the alternative method of choosing a producer’s name that would use the agency’s NPN is the best method to circumvent this issue and allow for agency authorization.

MHBE could amend authorized producer lists to include authorized agencies.

Proposed Changes

MHBE Authorized Producers

SHOP MARKETPLACE

1. Authorizing Agencies or Companies can be commenced as of January 1, 2017.

2. The action of authorizing agencies/companies would require an addition of a new application for entities alone and it would require:

A. Agency Maryland Insurance License

B. Agency E&O

3. MHBE would amend lists of authorized producers to include authorized agencies.

Proposed Changes

MHBE Authorized Producers

How would this proposed action of authorizing agencies affect carriers/ TPAs?

A. Individual Marketplace – sending agency NPN’s attached to one producer’s name rather than agency. The NPN would not match that producer’s name but rather the agency the producer is from. Would this cause issues with commissions?

B. SHOP Marketplace – How would authorizing agencies affect your process? Is there any downside for us to begin authorizing agencies?

Carrier Feedback

Action Items

Next Meeting Location

Action Item Review

• February 11, 2016, issuers needed to have provided MHBE with an extract of Exchange group Book of Business with Brokers and Subscribers. (Note: this is an outstanding item for some issuers)

• April, 2016: Issuers must submit the quarterly APTC reconciliation to MHBE (Note: this is an outstanding item for some issuers)

• May 2, 2016: Issuers must inform MHBE of the storage size for all of the required RI/RA reports, for SFTP configuration. (Note: this is an outstanding item for some issuers)

• July 1, 2016, Issuers should submit the completed survey by the initial QHP Application deadline.

• TBD – Final Issuer Renewal Notices & Plan Exit Notices to MHBE upon finalization

• June 6, 2016 MHBE will establish a uniform mailbox for Plan Management activities

Action Item Review

• June 6, 2016, MHBE will send PMSC the definitions for the network expansion types and will include the rubric for categorization after issuer self selection.

• June 6, 2016, MHBE will identify Renewal scenarios that have been utilized in 2015

• June 6, 2016 MHBE will establish a uniform mailbox for Plan Management activities

• June 10, 2016 MHBE will deliver the Final Determination Notice + Responses to PMSC Comment

• June 16, 2016 Issuer comment period closes for Interim Consumer Initiated Terminations procedures

Action Item Review

• June 24, 2016 Issuer and SHOP Administrators must transmit contract close-out enrollment information to MHBE.

• August 1, 2016 Issuers will submit their Renewals Action Plan to MHBE Plan Management by August 1, 2016

• August 5, 2016 MHBE will transmit receipt notifications for submitters to the Supplemental Reinsurance Program

• September 2, 2016 Issuer Marketing PDF Submission

• September 30, 2016 Carrier Video Submission Date

• October 13, 2016 Issuer Renewal Notices, Billing Policies, Talking Points and American Sign Language Indicator

• October 20, 2016 Mid-month APTC & Mid-month Termination

Action Item Review

Questions or Comments?