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Maryland Health care Reform Implementation Update NASTAD Annual Meeting

Maryland Health care Reform Implementation Update NASTAD Annual Meeting ACA: Preparing Programs for implementation May 21, 2012 Heather L. Hauck, MSW, LICSW Director MARYLAND Department of Health and Mental Hygiene Infectious Disease and Environmental Health Administration.

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Maryland Health care Reform Implementation Update NASTAD Annual Meeting

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  1. Maryland Health care Reform Implementation Update NASTAD Annual Meeting ACA: Preparing Programs for implementation May 21, 2012 Heather L. Hauck, MSW, LICSW DirectorMARYLAND Department of Health and Mental HygieneInfectious Disease and Environmental Health Administration

  2. Overarching Goal of Health Care Reform in Maryland Not about reform. Not about health care. IT’S ABOUT HEALTH

  3. Health Care Reform Coordinating Council • Executive and legislative branch leadership • 6 workgroups • 35 public meetings • Regional public hearings • Hundreds of public comments

  4. HCRCC Report: 16 Recommendations in 5 Categories Public Health, Safety Net and Special Populations Outreach and Education Improving Delivery System Leadership and Oversight Reducing Health Disparities

  5. Expanded Coverage and Projected Savings from Health Care Reform $850 million in savings to the Maryland budget over 10 years Access to affordable health care for more than 350,000 Marylanders by 2020 5

  6. Four Pillars of ACA Expanded Access to Health Care Stronger Insurance Coverage Cost Control and Quality Improvement More Affordable Insurance Coverage

  7. Pillar IIExpanded Access to Health Care Health Benefit Exchange: a transparent, competitive marketplace where individuals and small businesses can enroll in Medicaid and purchase private insurance coverage. 7

  8. Timeline for Health Insurance Exchanges 2011: Administration legislation established framework for a independent governmental entity to run the exchange 2013: Final adjustments and launch of Exchange 2014: Exchange operational 2012: After study and initial recommendations, possible legislation to refine exchange

  9. Health Benefit Exchange Bill Administration Package, signed 4/12/2011 • Signed into law April 12, 2011. • Established as independent unit of State government with a Board. • Specific provisions promote transparency, accountability, and flexibility. • Establishes core functions and duties required under the Affordable Care Act. • Identifies key policy issues to be studied and reported to Legislature in December.

  10. MARYLAND HEALTH BENEFIT EXCHANGE ACT OF 2012 CHAPTER 152 LAWS OF MARYLAND EFFECTIVE DATE JUNE 1, 2012 Infectious Disease & Environmental Health Administration May 2012 10

  11. OPERATING MODEL AND MARKET RULES • SCOPE OF EXCHANGE’S AUTHORITY:Exchange may sell only qualified health, dental and vision plans. • POWERS OF BOARD • RISK ADJUSTMENT AND REINSURANCE PROGRAMS • MHIP enrollees: Study re whether strategies should be employed to mitigate impact of high-cost MHIP enrollees in individual market. • EXCHANGE FINANCING • ADMINISTRATION OF EXCHANGE • TRANSFORMATION OF EXCHANGE INTO NON-PROFIT ENTITY • CERTIFICATION OF HEALTH BENEFIT PLANS MARYLAND HEALTH BENEFIT EXCHANGE ACT OF 2012 Infectious Disease & Environmental Health Administration May 2012 11

  12. SMALL BUSINESS HEALTH OPTIONS PROGRAM (SHOP) EXCHANGE Separate market: SHOP Exchange shall be separate from Individual Exchange. Goals: SHOP Exchange viability; increasing access to coverage; predictability for employers; employee choice; continuity of care for employees changing employers or plans. Purpose: To focus outreach on employers not offering insurance. Navigator functions: Shall conduct education and outreach, distribute information, and sell qualified plans; facilitate activities related to plan selection, enrollment, renewals, disenrollment, tax credit eligibility, referrals, and support. MARYLAND HEALTH BENEFIT EXCHANGE Infectious Disease & Environmental Health Administration May 2012 12

  13. MARYLAND HEALTH BENEFIT EXCHANGE INDIVIDUAL EXCHANGE NAVIGATOR PROGRAM Exchange, MIA, and DHMH roles and collaboration: Exchange administers and MIA regulates program; all three agencies collaborate to ensure consistency and compliance with all relevant laws, regulations, and policies; they may enter into MOU to govern administration and enforcement. Navigator program objectives:To focus outreach on individuals who do not have insurance; to utilize CBOs and other entities with expertise working with vulnerable and hard-to-reach populations; to provide seamless entry into all insurance plans and programs. Navigator program functions/ obligations: Program overall must perform all ACA-required functions, e.g., conduct education and outreach, distribute information about and facilitate selection, enrollment, renewal, and disenrollment in qualified plans; conduct eligibility determinations for Medicaid, MCHIP, and premium subsidies; provide ongoing support with respect to these functions.

  14. MARYLAND HEALTH BENEFIT EXCHANGE INDIVIDUAL EXCHANGE NAVIGATOR PROGRAM Services requiring certified navigators: Services that may be provided only by certified navigator are those related to sale, solicitation, and negotiation of qualified plans; include offering advice or facilitating qualified plan selection and enrollment and application of premium tax subsidies; do not include education and outreach, eligibility determinations for subsidies and Medicaid, and Medicaid enrollment. Navigator entities:Exchange will authorize CBOs and partnerships to be navigator organizations to perform certified navigator functions and Medicaid enrollment; entities may be authorized to do all functions or subset; DHMH must approve authorization to do Medicaid enrollment; entities may do education, outreach, and eligibility determinations without authorization; administrative/clerical exemption; must comply with all laws, regulations, and policies governing Medicaid.

  15. MARYLAND HEALTH BENEFIT EXCHANGE INDIVIDUAL EXCHANGE NAVIGATOR PROGRAM Certified individual navigators:Must complete training and hold certification to conduct services related to selection and enrollment in qualified plans; not required to have producer/ adviser license; must work for navigator entity; constraints applicable to entities apply also to individual navigators; certification expires every two years. Navigator certification process: Exchange will administer with assistance of MIA and DHMH; agencies may enter into MOUs to facilitate. Navigator training program: Exchange shall develop and implement training program with approval of Commissioner and consultation with DHMH. Independence of navigator entities and navigators:Navigators and navigator entities must be free of conflict of interest; carriers not responsible for their activities.

  16. MARYLAND HEALTH BENEFIT EXCHANGE ESSENTIAL HEALTH BENEFITS Definition and applicability of Essential Health Benefits (EHB): EHB shall be those in State’s benchmark plan and, notwithstanding any other benefits mandated by state law, shall be benefits required in all non-grandfathered plans offered in individual and small group markets inside and outside Exchange beginning 1/1/14. Objectives in selection of EHB: State seeks to balance comprehensiveness of benefits with plan affordability, accommodate diverse health needs to extent possible, and ensure stakeholder input. Selection of State benchmark plan: Health Care Reform Coordinating Council shall conduct public stakeholder process and make selection of State’s benchmark plan by September 30, 2012; Council has authority to select plan which is not subject to all State mandated benefits.

  17. MARYLAND HEALTH BENEFIT EXCHANGE ESSENTIAL HEALTH BENEFITS • Advisory Committee: EHBAdvisory Committee will reflect the gender, racial, ethnic and geographic diversity of State; shall include members representing lower income groups, minorities, individuals with chronic diseases and other disabilities; public health researchers and others with expertise in health disparities and needs of diverse populations; and health insurance and health industry representatives. • Role of EHB Advisory Committee • Review Wakely’s analysis of the ten eligible plans; • Provide its own input on the HCRCC’s options for selection; • Facilitate written and oral comment from other stakeholders and the public; and • Prepare a report summarizing the analysis and stakeholder input to be presented to the HCRCC for its consideration in making the benchmark selection. • Nominations: The Governor’s Office of Health Care Reform (GOHR) solicited nominations for membership on the Advisory Committee between April 19 and May 1. Over 60 nominations were submitted.

  18. BENCHMARK SELECTION WORK PLAN AND TIMELINE

  19. BENCHMARK SELECTION WORK PLAN AND TIMELINE

  20. BENCHMARK SELECTION WORK PLAN AND TIMELINE

  21. BENCHMARK SELECTION WORK PLAN AND TIMELINE

  22. Pillar IVCost Control and Quality Improvement: Save Money While Making People Healthier Higher quality and more efficient care delivery models: Pilots and demonstration project with leadership from doctors and hospitals Keeping people healthy: Investments in wellness and prevention Health Information Technology: Support ongoing efforts to develop Health Information Exchange and meaningful use of Electronic Medical Records

  23. Health Quality and Cost Council Revised EO released May 26, 2011 Council established in 2007 through Executive Order Public-private partnership Successful initiatives underway RESPONSIBILITIES Chronic disease management Support for ongoing efforts on HIT Elimination of health disparities Opportunities under the ACA Dissemination of patient-centered outcomes research among health care providers

  24. IN ADDITION, PUBLIC HEALTHIS ALSO FOCUSING ON….

  25. HCR Implementation Issues • Health Information Technology (HIT) • Infrastructure Capacity – Internal and External • Reimbursement models

  26. Key Public Health Relationships • Internal State Health Department • Epi and Lab • IT • Immunization Program • Medicaid (external to some) • NCHHSTP programs • External • State health information exchange • State health insurance exchange • State Insurance Administration • Community Health Centers/Primary Care Associations

  27. Health Information Technology • Increasing infrastructure • Health information exchanges • Electronic Lab Reporting • Increasing use of HIT • Disease reporting • Immunization registries • Secondary data use • Parallel timelines • HIEs with hospitals, labs, practices • Meaningful use • ELR connections • EHR connections

  28. Infrastructure Capacity • Public health/safety net providers need to have infrastructure to bill private and public insurances • May need state legislation or other authority to allow contracting • Provider shortage – Community Health Worker models have potential • Public Health Informatics • CBO/FBO alignment

  29. Service Delivery Reimbursement Models • Clinical care and CBO partnerships? • Patient Centered Medical Homes • Private insurance reimbursement for clinical services at public health sites • Insurance reimbursement for public health functions

  30. Maryland Infectious Disease and Environmental Health Administration http://ideha.dhmh.maryland.gov/ Infectious Disease & Environmental Health Administration May 2012 31

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