ACA
2014 & Beyond
Rhonda Fossitt
Senior Deputy Director
ACA: 2014 Michigan Successes
• 272,539 Michiganders enrolled in
Marketplace plans
• 13 Health Companies Participated in
Marketplaces
• Federal/State partnership protects
Michigan companies and consumers
ACA: Key Decisions
• Transitional Policy: Nov. 2013
• Extended Transitional Policy: April 2014
• SHOP (Small Business Health Options
Program) Employee Choice: June 2014
ACA: 2015 Challenges
• Short timeline to prepare & approve QHP
filings
• Pricing
• Late guidance
• Redetermination and renewals
2015 Perspective: A Game of Survivor
Turn-over of HHS
Staff
Late Release of
Review Tools
Transitional
Policy
Decisions
High Workload
Due to
Participation
Employee Choice
in SHOP Decision
Template
Challenges
Redetermination
and
Renewals
Interpreting Late
HHS Rules
5
Updates for 2015
• 18 Health Insurers file for participation on the
Marketplace
o Increase from 13 Health Insurers in 2014
o Competition fostered by effective & efficient regulatory
environment
• “2015 Marketplace Plan & Rate Information” added
to DIFS website to provide:
o
o
o
o
Rate Change Requests & Public Comments
Dental Information
Map of Rating Areas
SERFF Portal: Health Rates & Forms Filings
Deadlines for 2015
QHP
Application Submission and Review Process
Michigan Filing Deadline
Plan ID Crosswalk Template
DIFS Transfers Plan Data to CMS
CMS Reviews Plan Data
CMS Notifies DIFS of Necessary
Corrections to QHP Data
Final Deadline for Issuers to
Resubmit Data Into SERFF
DIFS Transfers Revisions to CMS
CMS Completes Re-Review of Plan Data
and State Recommendations
Limited Window for Plan Correction
QHP
Agreement/Final
Certification
Open Enrollment
Certification Notices and QHP
Agreements Sent to Issuers,
Agreements Signed, QHP Data Finalized
06/09/2014
08/04/2014
08/08/2014
08/11/2014
to 08/25/2014
08/26/2014
09/04/2014
09/05/2014
to 09/10/2014
09/22/2014
09/24/2014
to 10/06/2014
10/14/2014
To
11/03/2014
11/15/2014
Plan & Benefit Template –
Report from DIFS
• In Year 2
- actuarial value stayed fairly constant
- catastrophic plans understood
- out-of-pocket max understood
• Positive Feedback
- 25% of companies used data integrity tools & review tools
- most companies timely provided complete answers in objection
responses
- Ways to reduce errors & objections
- use data integrity & review tools
- check Plan & Benefit Template to be sure it matches forms
Preview of the Issues:
2016 and Beyond
• 1/1/2016: Definition of Small Group will
increase from 50 to 100 members
• 1/1/2016: Essential Health Benefits will be
redefined - criteria unknown
• 1/1/2017: State decision on whether we
would add large group to the SHOP
Resources that DIFS Provides
to Health Insurers
• Bulletins
• Industry Q & A Sessions
- Monthly MAHP Meetings
- These questions are added to FAQs on DIFS’ website
• FAQs on DIFS’ website
- Affordable Care Act - 11 Categories
• SERFF - State Messages
• Conference Calls
What Does HAPPY mean to DIFS
Health Plans Staff?
• A successful transmittal of a Binder
through SERFF to HHS
• The message that comes back indicates
“HAPI”
• We have gone with this theme