Maryland Health Benefit Exchange
Implementation Advisory Committee
Meeting
September 4th, 2014
A service of Maryland Health Benefit Exchange
Welcome & Approval of Minutes
Michele Eberle
Acting Director, Plan & Partner Management
Maryland Health Benefit Exchange
A service of Maryland Health Benefit Exchange
Renewal Outreach Program
Paul Barringer, Optum
A service of Maryland Health Benefit Exchange
MHC & 2015 Coverage Renewals
September 4, 2014
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Health Services is What Optum Does
Focused solely on health insurance and healthcare, Optum understands the purpose behind the health
insurance exchanges…
…Our dedicated public sector organization brings the full set of Optum capabilities to every government
customer to help the health system work better for everyone
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
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Optum’s Exchange Experience
• Optum has a proven track record in successfully supporting and
remediating the federal exchange as well as in supporting a number
of state health benefit exchanges.
• In Maryland, Optum/QSSI has assisted with:
 Enrollments
 Life events
 Data analysis and reporting
 Analytics support
 Renewals
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
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Renewing Coverage for 2015: Key Considerations
• Consumers who bought a health plan through Maryland Health
Connection in 2014 must renew coverage for 2015 to continue to
receive financial assistance or to determine eligibility for assistance
• Consumers who would like help with renewing have multiple options
for receiving assistance
• Consumers renewing independently must submit a new application at
www.MarylandHealthConnection.gov by December 18, 2014 to
ensure that coverage starts Jan. 1, 2015
• Consumers not successfully completing a new application at
www.MarylandHealthConnection.gov will receive a bill as of January
1, 2015 showing the cost of their plan without financial assistance
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
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Optum’s Role in Supporting Renewals
• Developing and maintaining a list of individuals with effectuated QHP
enrollments; tracking renewals through old and new systems
• Coordinating with brokers/producers and connector entities to provide
updated lists of consumers who elect in-person assistance
• Coordinating additional outreach (including automated dialing and
email campaigns) to encourage renewal enrollments
• Supporting outreach initiatives by MHBE to encourage consumers to
re-enroll in a timely basis
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
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Renewals Outreach Activities
• E-mail, letter and phone call to invite consumers to participate in
tracking program and receive free in-person assistance completing
their renewals application
• Social media campaign
• Paid media campaign
• MarylandHealthConnection.gov webpage will have detailed
information on the renewals process
• Multiple Notices sent by MHBE throughout open enrollment and post
enrollment
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
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Call to Action Schedule
Call to Action 1:
Call to Action 2:
Call to Action 3:
MHBE: Oct 1st
Carriers: Nov 10-15th
Carriers: Dec 1st
- Inform consumers of
renewals process
- Provide opportunities for
in-person assistance to
renew
- Description of
redetermination and
renewal process
- APTC and CSR received
in 2014
- Deadline reminder for 1/1
coverage
- Explanation of the
automatic renewal process
- Explanation of tax
reconciliation
- Option to purchase
coverage w/o financial
assistance directly through
the carrier
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
10
Call to Action 1 (Oct. 1st) from MHBE
MHBE will send a description of the annual redetermination and renewal process
which addresses the following:
• Individuals will need to have an eligibility redetermination – through the website,
navigator, producer or call center – to be considered for financial assistance in 2015.
Those who do not have an eligibility redetermination and select a plan through the
website will be automatically renewed into an exchange plan without APTC or CSR.
• Individuals will have the option to see all health plans through the new website, and may
enroll in the same plan they had for 2014 or choose a different one.
• Individuals will have the ability to get assistance through producers, navigators and
others for renewal through the website – and how to access such assistance.
• A description of the reconciliation process at tax time.
• The requirement to report changes to information affecting eligibility and the timeframe
and channels through which changes can be reported.
• The option to purchase coverage without any financial assistance by going directly to a
carrier.
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
11
Call to Action 2 (before Nov 15th) from Carriers
Carriers will send a description of the annual financial assistance eligibility
redetermination and renewal process which addresses the following:
• Individuals will need to have an eligibility redetermination through the website, navigator,
or call center, to be considered for financial assistance in 2015. Those who do not have
an eligibility redetermination and select a plan through the website will be automatically
renewed into an exchange plan without APTC or CSR.
• A reminder of their APTC and CSR received in 2014.
• The option to see all health plans through the new website.
• The ability to get assistance through producers, navigators and others for renewal
through the website, and explanation on how to access such assistance.
• A description of the reconciliation process at tax time.
• The requirement to report changes to information affecting eligibility and the timeframe
and channels through which changes can be reported.
• The option to purchase coverage without any financial assistance by going directly to
carriers.
• If they take no action to get a eligibility redetermination, they will be automatically
renewed without financial assistance, including: dates of renewal period, health benefit
plan rates, terms of coverage, the deadline to avoid automatic renewal.
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
12
Call to Action 3 (~ December 1st) from Carriers
• Carriers will send a notice about the default of automatic renewal, with the
premium and payment deadline.
• We will have a session with MIA to identify ways to provide this information
without confusing consumers from the core message of encouraging
redetermination.
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
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Notice Coordination
MHBE and insurance carriers share the responsibility to send notices
and conduct sufficient outreach to consumers
• Consistency in message content
• Alignment in message timing
• Maximize communication to consumers
• Multiple perspectives on reasons to renew
• Opportunities to reduce redundancy and sync notices
• Ensure that all legal requirements are met
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
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Renewing after Open Enrollment
• After open enrollment, and on an ongoing basis, Optum will provide
carriers with a list of individuals who have not renewed in the new
system.
• Carriers will renew these individuals in on-exchange plans without
APTC and CSR.
• Optum will continue to track individuals who did not renew in the new
system through open enrollment.
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
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MHBE and Carrier Outreach and Coordination
Outreach Efforts
to Encourage
Consumers to
Renew
Consumer
renews
enrollment
through the
new system
Consumer does
not renew
enrollment
through the
new system
Post 12/18,
consumers
renew through
the new system
Optum provides list of
individuals to carriers
who did not renew
through the new
system
Carriers renew
individuals in onexchange plans
without APTC or CSR
for 1/1 coverage
Effectuate in
carrierrenewed plan
Cancelled due
to nonpayment in
carrierrenewed plan
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
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Questions / Comments?
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
Renewal Timeline
Michele Eberle, Plan Management
A service of Maryland Health Benefit Exchange
CRISP Presentation
Jeremy Wong, CRISP
A service of Maryland Health Benefit Exchange
CRISP Provider Search:
Open Enrollment and Error
Correction Update
September 4, 2014
Current State and Open
Enrollment 2014-2015
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CRISP Provider Search Website –
Search by Provider
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CRISP Provider Search Website –
Provider Profile
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Current State – Site Usage
Site Stats
65,000 visits since 10/1/13
300 visits per day during Open Enrollment
• Last week of March: 700 visits per day
• March 31, 2014: 1,674 visits
• December 31, 2014: 1,000 visits
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Connecticut Migration
The Connecticut system has no integrated
provider data
• Consumers are linked to the carriers’ provider
directory
Maryland consumers will be linked to the CRISP
Provider Search site
• For Open Enrollment 2014, the CRISP Provider
Search site will be the sole way to access provider
data
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Current State – Data Flow
Consumer
Sites
Provider
Error
Corrections
CRISP Provider Search
Maryland Health
Connection
CRISP
Provider Data
Processing
Optum (P360 Data Scrubbing)
Data
Submission
QHPs
MCOs
Currently, CRISP relies on carriers to make error
corrections
Current Provider Error Correction Process
1. Providers report errors to CRISP
2. CRISP determines which carrier(s) submitted
the error
3. Each month, CRISP submits a Provider Error
Report to each carrier
4. Carriers follow-up with providers to resolve
errors
5. Carriers correct errors in subsequent biweekly submissions to CRISP
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Open Enrollment – Data Flow
Consumer
Sites
Provider
Error
Corrections
CRISP Provider Search
CRISP
Provider Data
Processing
Optum (P360 Data Scrubbing)
Data
Submission
QHPs
MCOs
Error Correction
Initiative
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CRISP has received various feedback
detailing inaccuracies in provider data
Provider errors can be divided into two
categories:
• Demographics errors involve providers’
addresses, phone numbers, and office hours
• Network errors involve specialty and disputed
inclusion in a carrier’s network
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Error Correction Pilot
CRISP is currently conducting an Error Correction Pilot
Unified portal where providers can view carrier-submitted
information and submit updates
• Demographics corrections (addresses, locations, and office
hours) can be made immediately
• Network corrections would be submitted to the appropriate
carrier(s)
CRISP is developing provider identity proofing
The Error Correction functionality is on-target to be
live by late 2014.
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CRISP will develop appropriate “trust levels” with Optum to
ensure corrections made align with MHBE business goals
Develop “trust levels” with Optum to determine
which provider information is displayed
• Optum will trust CRISP data (over carrier data) for
approved demographics fields and make real-time
corrections
• Optum will trust MCOs and QHPs for network
corrections
32
Automated Carrier Error
Reports
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CRISP is developing methodology for sending
automated Error Reports to carriers
Proposed File Requirements
Distinguish between Demographics and Network Corrections
• Carriers should update provider information based on Demographics
Changes
• Carriers should adjudicate Network Changes with carrier and make
changes in subsequent CRISP Input Files
Identify if information should be added or removed for a provider
The text file will be delivered to a SFTP location every day for which
there is an error correction submitted to CRISP for that carrier.
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CRISP recommends a pipe-delimited flat
file
Proposed File Format
1. CRISP proposes a pipe-delimited text file.
2. The file will include identifying information about the
provider (e.g., first name, last name, and NPI)
3. Corrections will be tagged as either as
“Demographics” or “Network.”
4. Corrections will be tagged with “add” or “remove” –
followed by the relevant piece of information.
Demographics|Remove|Address|1 Main
St.||Columbia|MD|21046|4435551212
Network|Add|Specialty|Cardiology
Network|Remove|All CareFirst plans
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Next Steps
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Next Steps
1. CRISP will distribute a final Error Correction File
Format and Delivery document
2. Carriers can respond with questions or suggestions
3. When development is complete, CRISP will invite
carriers to test functionality and provide feedback
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HIX Update
Nabila Rahman, Optum
A service of Maryland Health Benefit Exchange
MHBE IAC
System Update
September 4, 2014
A service of Maryland Health Benefit Exchange
Glossary
SIT – System Integration Testing
UAT – User Acceptance Testing
EDI – Electronic Data Interchange
Release 1 – Plan Management
Release 2 – Eligibility & Enrollment
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Agenda
System Implementation Timeline
Release 1 UAT
Release 2 SIT & UAT
Meetings
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System Implementation Update - Timeline
Today
UAT
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Release 1 UAT
Last week, carriers should have received
– Rate data extract
– Benefit data extract
Benefit data extract contains multiple errors
– New file will be emailed by COB Friday, September 5
– Submit feedback by COB Wednesday, September 10
Continue validating rate data
– Submit feedback by COB Friday, September 5
– Received feedback that the rate extract is rounding incorrectly. Continue to
validate and let us know if you see this issue.
Submit Individual SBCs by September 10
43
Release 2
SIT
– Received feedback from the emailed screenshots of plan shopping experience
from SIT environment.
• Investigating your feedback.
– Ongoing EDI 834 testing – please reach out if you have concerns
UAT
– Thank you for submitting names for onsite testing.
– September 15 – September 19: individual meetings with each carrier to walk
through portal
– September 22 – October 3: unstructured carrier UAT testing
• Access to anonymous browsing
• Ability to confirm rates and plan display
– October 13 – October 17: structured carrier UAT testing
• Full access to end-to-end system – hitting the FDSH, identity proofing, generating 834s,
etc.
• Utilize MHBE-defined scripts
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Meetings
Daily EDI 834 testing calls (short term)
Weekly Plan Management and Operational calls
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SHOP Update
Stephanie Lee, MHBE Plan Management
A service of Maryland Health Benefit Exchange
Dental Updates
Michele Eberle, MHBE Plan Management
A service of Maryland Health Benefit Exchange
Renewal of 2014 SADP’s
Tax subsidies have been rarely applied to dental policies per the
National Association of Dental Plans (NADP)
Dental benefits maintain a HIPAA-excepted benefit status
Dental benefits are exempt from guaranteed renewability
Renewal notices are not applicable to SADP’s, but NADP has
encouraged members to use them
The FFM is including SADPs in their auto-renewal process
Md. Insurance Code Ann 15-122 (a) (4) includes the renewal
requirements for carriers and defines carriers as including dental
plans
About 7000 consumers purchased SADP’s through MHC in
2014, mostly family dental plans
CMS is borrowing the uniform modification of coverage test for
the purposes of recertification of SADP’s [CMS FAQ 2639,
7/3/14]
Renewal of 2014 SADP’s
Items being addresses
If a consumer wishes to reenroll and maintain their QHP but
change their SADP, how will the consumer be instructed to
do so?
If a consumer wishes to maintain their SADP but change their
QHP, how will the consumer be instructed to do so?
How will reenrollments occur if a consumer does not come
back through the MHC website for reenrollment? Will
coverage end? Will dental carriers need to automatically reenroll in the same plan?
What reporting requirements will MHBE have of dental
carriers for renewing members?
Are dental carriers to planning to send notices to members
regarding reenrollment?
2015 Dental Plan Display
Michele Eberle, MHBE Plan Management
A service of Maryland Health Benefit Exchange
PUBLIC COMMENTS?
NEXT MEETING:
September 18th, 2014
2:00 – 4:00PM
UMBC Tech Center
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