Nevada Health Link Legislator Briefing: Supported State-Based Marketplace Transition Overview

Nevada Health Link New Legislator Policy Briefing December 3, 2014

Presentation Topics Transition to Supported State Based Marketplace Open Enrollment Overview Consumer Case Resolution Initiative Exchange contact information 2

SUPPORTED STATE BASED MARTKETPLACE TRANSITION

What is an SSBM? Supported State Based Marketplace Exchange provides health plan qualification and certification services, oversees and underwrites the cost of in-person assistance programs, develops and funds marketing and consumer outreach efforts, acts as liaison between carriers and federal hub. Federal government provides technology: the eligibility and enrollment operational platform utilized by the Exchange. Halbig-proof , subsidies safe 4

Part of Multi-Agency Team The Exchange works with a multi-agency team for project management Centers for Medicare and Medicaid Services (CMS) Nevada Governor s Office Division of Welfare and Supportive Services (DWSS) Division of Insurance (DOI) Enterprise IT Services (EITS) 5

Stakeholder Liaison The Exchange also works with external resources and stakeholders for the benefit of Nevada s consumers Consultants on technology integration and messaging Insurance carriers Brokers and agents Exchange enrollment facilitators 6

Technical Resource Developed a pathway to successful transition Set benchmarks Configuration milestones Set up and transition milestones IT Security milestones Organization and resources milestones Managed carrier onboarding and transitioning 7

Operational Resource Plan certification DOI, Exchange and carriers working together New market entry Time Insurance Company (PPO) Marketing and outreach Educational and promotional campaigns Sponsor events and enrollment stores Broker and agent education Must register with CMS Complete specified training Facilitator education Navigator program required as SSBM Complete specified training 8

OPEN ENROLLMENT

Goals Don t burn the house down again, please Improve the consumer experience Mitigate/eliminate root causes of last year s issues Provide expanded access to in-person assistance 10

Strategies Adopt federal technology platform to: Make signing up easier and faster Assure data capture and transmission Leverage federal technology infrastructure and resources Transfer premium billing and collection activities to the insurance carriers End the need for reconciliations Minimize the potential for misallocation/errors Emulate successful outreach programs of other states Create brick and mortar enrollment assistance centers Integrate community calendars, other tools 11

The New Platform Significant changes in Healthcare.gov from 2014 Streamlined application form: 76 screens reduced to 16 Can handle 250,000 simultaneous users Ability to window shop for plans without creating an account Back button Authorization/verification at conclusion of the process rather than page by page

Does it work? Yes! Positive press Health exchange enrollment off to a smooth start Las Vegas Sun Health coverage enrollment gets good early reviews Las Vegas Review Journal Reviews good for Nevada Health Link enrollment KLAS TV No substantial/widespread consumer complaints No constituent services complaints 13

In person assistance Enrollment stores in Las Vegas and Reno opened November 15th Staffed with brokers, agents, navigators and Medicaid enrollers Well received Positive consumer experiences Ability to get immediate assistance with website, insurance related questions 14

Initial Assessment 90 day race Early results and impressions are positive Messaging has been successful Technology has been stable and robust Demonstrating the value of the exchange as a technical and operational resource, impact of state specific marketing and outreach 15

CONSUMER CASE RESOLUTION INITIATIVE

Overview Issues surrounding 2014 Plan Year Open Enrollment well documented Enrollment Eligibility Advanced Premium Tax Credit Billing Repeating data anomalies and inconsistencies 17

Remedial Actions Committed, all hands on deck efforts as soon as problems began to reveal themselves Constant communications with vendor Requested reporting by issue type to track trends Development of vendor Special Case Resolution group A staff member and a representative of Xerox are meeting with each carrier to review open cases and identify opportunities for resolution 18

Added Resources Strategic initiative to more quickly move consumer issues toward resolution and closure Two existing vacant staff positions have been filled and dedicated to resolving consumer issues Public Consulting Group has been retained and begun work on reconciling enrollment and financial discrepancies Prioritized, continuous and full-time effort 19

Root Causes Addressed Enrollment will be through federal platform, minimizing potential for issues created by prior system failing to properly capture and share data Billing will be handled by the carriers, ending the need for financial reconciliations and payment allocation errors

CONCLUSION

Progress Managed transition to an SSBM successfully Navigated the first days of open enrollment successfully Messaged the importance of coverage and the availability of local in-person assistance successfully Resolved last year s greatest dissatisfiers successfully

Open items Consumer case resolution Termination of Xerox relationship Structural transformation to better reflect the SSBM model

Contacting the Exchange 2014 Issues Shawna DeRousse sderousse@exchange.nv.gov 702.486.5262 Constituent Services Matt Robinson mrobinson@exchange.nv.gov 775.687.9936 Executive Director Bruce Gilbert bgilbert@exchange.nv.gov 775.687.9926