Maryland Health Benefit Exchange: An Update

1. Maryland Health Benefit Exchange: An Update October 5, 2011 Charles Milligan DHMH Deputy Secretary, Health Care Financing

2. Health Care Reform Coordinating Council • Six workgroups formed in 2010, including Exchange and Insurance Markets • Sixteen recommendations published December 2010, one relating to the governance of the Exchange • The council continues to play an essential role coordinating the various agencies and branches of government in health reform in Maryland

3. Maryland Health Benefit Exchange Act • Enacted April 12, 2011, this Act established the Exchange as an independent public entity • Statute focused on governance; deferred controversial topics (“one step at a time”) • Exchange has its own procurement system, conflict of interest policy, and personnel system • 9 member Board of Trustees (“Board”); three ex officio; six appointed by Governor • Directed the Exchange to conduct specific studies and make recommendations

4. Maryland Health Benefit Exchange 2011 Board-approved Org. Chart

5. Legislative Study Process • Six requests for proposals were released in July and August 2011 • The Board selected vendors to conduct the six legislatively-mandated studies • Advisory committees were created to provide stakeholder perspective • Separate reports from vendors and advisory committees are due to the Board on November 15, 2011

6. Legislative Study Process Legislature Formal Recommendations Exchange Board Neutral, informative Report Vetted options paper Provide experiential support Study Vendor Advisory Committee Provide analytic support

7. Advisory Committee Process • Four advisory committees, made up of a variety of stakeholders, including individuals, small business owners, brokers, and physicians • Tasked with working collaboratively with vendors to vet options regarding key policy issues • Meetings are taking place October and November of 2011 • The public is encouraged to attend and participate in these meetings

8. Operating Model and Insurance Rules Advisory Committee Scope of Work: • Consider the feasibility and desirability of the Exchange engaging in selective contracting and/or multistate or regional contracting • Consider the rules under which plans should be offered inside and outside the Exchange, including risk selection, reinsurance, and risk corridors Legislative Studies: • Operating Model Study (Wakely Consulting Group) • Market Rules and Risk Selection (Mercer)

9. SHOP Advisory Committee Scope of Work: • Consider the design and operation of the SHOP Exchange, including: • How employers shall offer plans to their employees • Whether the current and individual small group markets should be merged • Whether the SHOP Exchange should be made available to employers with 51-100 employees prior to 2016 Legislative Studies: • SHOP Study (Institute for Health Policy Solutions)

10. Navigator and Enrollment Advisory Committee Scope of Work: • Consider the design and operation of the Exchange’s Navigator Program and any other appropriate consumer assistance mechanisms, including user experience • Consider how the Exchange should conduct its public relations and advertising campaign Legislative Studies: • Navigator Study (Manatt) • Public Relations and Advertising (Weber Shandwick)

11. Finance and Sustainability Advisory Committee Scope of Work: • Consider the budget of the Exchange • Consider the user fees, licensing fees, or other assessments that could be imposed by the Exchange to fund its operations, including what type of user fee cap or other methodology would be appropriate to ensure that the income of the Exchange comports with its expenditures • Consider ways to prevent waste, fraud, and abuse Legislative Studies: • Finance and Sustainability (Wakely)

12. Establishment Grant • On August 12, 2011, Maryland received a $27.2 million Establishment Grant • The grant will help the Board: • Hire initial staff and run operations • Analytic work, including (but not limited) to prescribed legislative studies • Develop the information technology infrastructure for eligibility and enrollment

13. Requests for Proposals • The Board is releasing three requests for proposals by mid October: • The Call Center Study will develop an inventory of current Maryland consumer assistance call centers and their capabilities, an analysis of consumer assistance data received through these call centers, and develop a road map for consumer assistance call center support

14. Requests for Proposals • The Take Up Study will develop a dynamic enrollment modeling tool for the Exchange to simulate and monitor potential enrollment in the Exchange and the characteristics of individuals who are likely to enroll in the Exchange • The IT Systems will design a modern, consumer-friendly Health Benefit Exchange eligibility and enrollment system

15. Next Steps • The Board is prepared responses to four proposed rules released by HHS related to the Exchange • The Board will make recommendations to legislature regarding the legislative studies by December 2011 • Additional staff will be hired • The purchasing and coordination relationship with Medicaid will be advanced

16. Contact Information Charles Milligan Deputy Secretary, Health Care Financing DHMH cmilligan@dhmh.state.md.us