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Plan Management Meeting - November 19, 2013

Policy/Legislative update, monitoring and compliance, 2015 plan management preparation. Feedback and suggestions requested.

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Plan Management Meeting - November 19, 2013

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  1. Audio: 1-866-244-8528; passcode 474987Plan Management MeetingNovember 19, 2013

  2. Agenda

  3. Policy/Legislative Update Michael Arnis Associate Policy Director

  4. Provider Directory Dustin Arnette Plan Manager

  5. Provider Directory • Post “go-live” feedback • National Provider Identifier (NPI) • Making this a required data field • Future Enhancements: • Static “inbound” folder • Expanded search radius • Adding clinic name to search and results • Search by issuer • Specialty search • New entrants and transition for 2015

  6. Monitoring and Compliance Dustin Arnette Plan Manager

  7. Monitoring and Compliance • Ensure ongoing compliance with certification criteria after initial certification • Federal regulations applicable to operation of a State-based Marketplace (“SBM”) • Additional details in the Guidance for Participation documents: • Section 2.4 – Monitoring and Compliance of Qualified Health Plans (p. 17) • Section 2.3 – Monitoring and Compliance of Qualified Dental Plans (p. 13)

  8. QHP & QDP Compliance and Monitoring Dashboard May 2014 Fictitious data for discussion purposes only

  9. QHP & QDP Compliance and Monitoring Dashboard May 2014 Full Carrier Report (excerpt) Fictitious data for discussion purposes only

  10. QHP & QDP Compliance and Monitoring Dashboard May 2014 Summary of Noncompliance Fictitious data for discussion purposes only

  11. QHP & QDP Compliance and Monitoring Dashboard May 2014 Complaint and Enrollment Metrics Fictitious data for discussion purposes only

  12. 2015 Plan Management Preparation Susanne Towill Senior Plan Manager

  13. Reflection on 2014 • Lessons Learned • Communication methods • Benefit data translation • Timeline and flow • Third party QA • Feedback Requested • What worked well for you? • What can be improved for this year? • Other thoughts? • Further feedback can be sent to: QHP@wahbexchange.org

  14. Preparing for 2015 • Communications: • Bi-Monthly Meetings • Alternating Bi-Monthly Newsletter • Plan Management Webpage refreshed • Timeline & Flow • Coordinating drafting with federal and state requirements • Guidance for Participation • Goal to publish drafts in December and final February 1st. • CMS Data Templates • Providing feedback to CMS

  15. Guidance For Participation Zach Snyder Plan Manager

  16. 2013 QHP/QDP Guidance For Participation

  17. Needed Revisions • Update Regulations • Plan Management Timeline • Checklist • Suggestions?

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