2013 Legislative Preview

1. 2013Legislative Preview Sponsored by: Presenting Sponsor Media Sponsor

2. Tequila Terry Director of Plan and Partner Management Maryland Health Benefit Exchange

3. Maryland Nonprofits Legislative Preview Meeting January 7, 2013

4. Topics • What is a Health Insurance Exchange? • The Maryland Health Connection • Establishment Legislation • Implementation Update • Ways to Get More Information

5. What is a Health Insurance Exchange? • The Patient Protection and Affordable Care Act requires each state to establish a “health insurance exchange” by 2014. • Maryland is creating its exchange to be an accessible and competitive marketplace for Marylanders to search for and enroll in affordable health insurance plans as well as determine eligibility for Medicaid and federal tax credits.

6. What is the Maryland Health Connection? • The Maryland Health Connection is the new name for Maryland’s health insurance exchange. • The Maryland Health Connection is a marketplace where individuals, families and small businesses can: • Compare health insurance options • Calculate total out-of-pocket costs based on eligible subsidies or tax credits • Enroll in the health plan that’s best suited for their needs

7. Individuals & Families • The Maryland Health Connection offers tax credits and cost sharing subsidies to individuals and families who do not have access to affordable healthcare insurance • Federal government will pay a portion of costs for health insurance for people who earn up to 400% of FPL • Cost sharing subsidies are available to individuals under 250% of FPL • Open Enrollment Period Begins: Oct. 2013 • Coverage Effective: Jan. 2014

8. Small Businesses • The Maryland Health Connection will have a Small Business Health Options Program (SHOP) dedicated portal for small businesses and their employees • Small businesses (including non-profits) with up to 50 employees may participate • In 2016, employers with up to 100 employees will be able to participate • Open Enrollment Period Begins: Oct. 2013

9. Small Businesses SHOP Highlights • Tax Credits for Health Insurance will only be available through Maryland Health Connection beginning October 1, 2013 as part of the ACA • The SHOP will provide employers: • Innovative plan options that are easy to administer • Access to tax credits to cover employee premiums • Ability to work with TPAs, brokers and agents as they do today

10. Establishment Legislation • Health Care Reform Coordinating Council • Created in 2010 to advise State government on the implementation of federal health care reform • Expand quality and affordable health care • Reduce waste and control costs • Health Benefit Exchange Act of 2011 • April 12, 2011: Governor O’Malley signed the Maryland Health Benefit Exchange Act to establish Maryland’s exchange as a public corporate and independent unit of state government • June 3, 2011: Exchange Board held its first meeting • September 2011: Exchange appointed Executive Director

11. Stakeholder Engagement Policy decisions were made through an open, transparent process with over 60 stakeholders from across Maryland (Fall 2011) • Four Advisory Committees studied six topics: • Navigator and Consumer Assistance / Advertising • Market Rules and Risk Selection / Operating Model • SHOP Exchange • Financing the Exchange • Executive Director and Board Liaisons attended all 22 meetings • Stakeholder representation included: health insurance industry, providers and associations, community members, advocates, community-based organizations, academia, business owners and leaders, local government officials, consumers, consultants

12. Health Benefit Exchange Act of 2012 • Options laid out in the stakeholder advisory committee process fed the recommendations from the Exchange Board to the General Assembly • These recommendations fed the 2012 Exchange bill • Senate Bill 238 and House Bill 443: Maryland General Assembly recently passed (April 5, 2012) legislation that outlines the implementation policies and procedures for operating the exchange

13. Implementation Update

14. Level Two Establishment Grant • Maryland was one of four states to receive a Level Two Establishment Grant on Thursday, August 23, 20121 • Total amount of award: $123 million • Funds will be used to support key implementation activities • Policy Development • IT Infrastructure Development • Creation of Operations & Administration Protocols • Consumer Assistance Programs • Outreach & Education Program 1Cooperative Agreement to Support Establishment of State-Operated Health Insurance Exchange (93.525)

15. Conditional Certification Received • On December 10th, Maryland was among the first six states in the U.S. to receive conditional approval from the Centers for Medicare & Medicaid Services (CMS) to operate a state-based health insurance exchange in 2014. • Conditional certification indicates that Maryland will be operationally ready for open enrollment beginning October 2013 and meets the requirements of the federal government.

16. Maryland’s Essential Health Benefits • The ACA requires that all insurance plans sold inside and outside the health benefit exchanges in the individual and small group markets cover “essential health benefits” (EHB) • EHBs must include items/services in the following categories: • Ambulatory services • Emergency services • Hospitalization • Maternity and newborn care • Mental health and substance use disorder services • Prescription drugs • Rehabilitative and habilitative services and devices, • Laboratory services • Preventative and wellness services and chronic disease management • Pediatric services including oral and vision care • The Maryland Health Care Reform Coordinating Council conducted an inclusive, public stakeholder process to select Maryland’s EHB package.

17. Technology • High-Level Technology Milestones • Phase 1A Vendor Award – March 2012 • Development Kick-Off – May 2012 • Federal Requirement Testing – November 2012 • State Requirement Development & Testing – 1st QTR 2013 • Integrated end-to-end Testing (Includes External Stakeholders) – 2nd QTR 2013 • Production Environment Live – 2nd QTR 2013 • Open enrollment – 10/1/2013

18. Consumer Assistance • Consolidated Service Center • Streamlined application, customer service through statewide Call Center • Navigators • Conduct public education and outreach as required by the Affordable Care Act • Distribute fair and impartial information • Facilitate enrollment in health plans • Provide referrals for grievances, complaints and questions • Provide information in a culturally and linguistically appropriate manner • Maintain expertise in eligibility, enrollment and program specifications • Refer INSURED SMALL GROUPS back to producers • Producers • Serve an important role in the Exchange • Continue to work directly with small group customers • Register to become authorized to sell QHP inside the Exchange • Be compensated directly by the carriers (as they currently are) • Receive training from the Exchange

19. What’s Next? • Continued Development of IT System • Outreach & Education: Q2 2013 • Open Enrollment: October 2013

20. Looking Ahead Next Steps • Visit www.MarylandHBE.com • Speak with a CPA about tax credits • Visit www. smallbusinesstaxcredits.org for more information • Speak with your insurance broker about the changes underway to find out what health insurance options will best meet the needs of your employees • Visit the IRS website for more information

21. Thank you! For questions on the information contained in this presentation, please contact: Tequila Terry Director, Plan & Partner Management Maryland Health Benefit Exchange Phone: 410.358.5618 Email: Tequila.Terry@maryland.gov www.MarylandHBE.com