Health Insurance Exchange
Project (HIX)
PCC Planning Certification 1/18/12
1
HIX Agenda
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Project Objectives
Planning Phase Certification
Funding and Budgets
Next Steps
2
HIX Objectives
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Create an integrated Health Insurance Exchange
Meet the deadlines associated with Health Care Reform Requirements
for PPACA HIX
Support the Agency in streamlining applications; providing integrated
screening, choice, coordination, eligibility and enrollment; aligning
systems to support health plan selection; and aggregating payments
to meet the projected enrollment of 55,000 in 2014, and up to 250,000
currently uninsured NM citizens in HIX between 2014 and 2020
Allow citizens to access services through a common portal via the
internet, for online application completion, multiple program eligibility
determination, and PPACA requirement verification
Implement a modern technology that meets HSD business needs, is
flexible to changing requirements, and is easily maintainable
Create a single integrated solution built on an n-tier architecture
3
IT Interfaces for NMHIX, Medicaid, Federal Data Hub
“No Wrong Door”
Portals
Plan Enrollment Confirmation
Displayed on HIX
Navigator
Broker
NMHIX
Eligibility
Determination
SHOP &
COMPARE
MEDICAID
Determination
Results
Individual
ISD2R
Plan Selection
Eligibility
Results & Plan
Selection
MMIS
ISD2R
NMHIX
Enrollment
Roster
Clinics
Hospitals
Non-Subsidized
Plan Selection
Enrollment
Confirmation
Carrier
Enrollment
Confirmation
Federal Data
Services Hub
BCBS
LHP
Molina
PHP
United
Amerigroup
IRS, SSA, HHS
4
Planning Phase
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Requesting certification for $832,252
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Includes
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Project Management & IV&V Services
Request for Proposal for procuring a Health Insurance Exchange
System
State Staff
5
Project Funding & Budget
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In November 2011 New Mexico received Notice of Award for a Level
I Health Insurance Exchange Establishment Grant to establish the
New Mexico Health Insurance Exchange (NMHIX). A total of
$34,279,483 in funding was received as part of Grant.
A total of $23,950,000 of the Grant Funding has been established
for the information technology portions of the HIX Project.
6
Next Steps
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Actions:
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Issue RFP for HIX IT System
Apply for Level II Grant - March 2012
Certify Implementation Phase
Execute Contract with selected Vendor
Procure IV&V Services
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See slide 8 for project schedule
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7
HIX Schedule 12.27.11.pptx
HIX
Project Schedule
Procurement
Develop / Test
Pilot
Statewide
4th Qtr
5/1/2012
2/01/2012
Release RFP
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Procurement
30 Days on
Street
15 Days to
Review
15 Days Demo
30 Days
Contracting
Vendor Start
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Release RFP
Vendor Start
Develop and Test (12 mths)
Pilot HIX Application
Roll Out HIX
Enroll into HIX
HIX Statewide
1/1/2014
HIX Open
Enrollment
2/1/2012
6/1/2012
9/1/2012 – 10/1/2013
4th Qtr 2013
4th Qtr 2013
10/1/13
1/1/2014
Questions
9