|
The Executive Board of the Health Benefit Exchange (HBX) Authority held its first meeting on Monday, July 23. Mayor Vincent Gray welcomed the board members and spoke about the important work they will do to help implement health reform in the District. Deputy Mayor for Health and Human Services BB Otero also attended the meeting, serving as chair, and expressed the District’s support of the Health Benefit Exchange.
During the inaugural meeting, the Executive Board was briefed on the District’s activities over the last several months to design and implement the HBX, including status reports from each of the Health Reform Implementation Committee (HRIC) subcommittees. Additionally, drafts of the HBX Charter and By-laws, as well as a job description for the Executive Director position, were discussed with the Executive Board.
Additional priorities for the new Executive Board include reviewing and adopting procurement and hiring policies and procedures, locating office space, and establishing an Advisory Board. The HRIC subcommittees and Health Care Reform and Innovation Administration will continue to provide HBX implementation support to the Executive Board.
The Executive Board has eleven members - seven voting members who were appointed by the Mayor and confirmed by the DC Council and four ex-officio non-voting members:
Voting Members
- Dr. Henry J. Aaron, Senior Fellow, Brookings Institution
- Dr. Mohammed Akhter, former Director, Department of Health
- Kate Sullivan Hare, Director of Policy Outreach and Public Affairs, Robert Wood Johnson Foundation
- Dr. Leighton Ku, Professor of Health Policy and Director, Center for Health Policy Research, George Washington University
- Diane C. Lewis, Health Care Policy Consultant
- Kevin Lucia, Research Professor and Project Director, Health Policy Institute, Georgetown University
Ex Officio Members:
-
David Berns, Director, Department of Human Services
-
Dr. Saul Levin, Interim Director, Department of Health
-
Wayne Turnage, Director, Department of Health Care Finance
-
William White, Commissioner, Department of Insurance, Securities and Banking
The next Executive Board meeting is scheduled for Tuesday, August 7 at 6:30 pm at 441 Fourth Street NW, Room 1107. Meetings of the Board are open to the public. Please check the calendar on the health reform website for the times and locations of future meetings.
 Mayor Vincent Gray administers the oath of office to four of the members of the HBX Executive Board. From left, Dr. Mohammed Akhter, Khalid Pitts, Kate Sullivan Hare, and Dr. Leighton Ku.
The Health Benefit Exchange (HBX) Executive Board is required to set up an Advisory Board whose members will provide advice on key issues for the HBX. Individuals with expertise as health professionals; health insurance or exchange consumers; disease, demographic, or consumer interest advocacy groups; commercial or public sector health plans; insurance brokers; or health care foundations can serve on the Advisory Board. DC residency is required.
Recommendations for Advisory Board members should be sent to Bonnie Norton, Acting Director, Health Care Reform and Innovation Administration, Department of Health Care Finance, at Bonnie.Norton@dc.gov.
As a result of the Affordable Care Act (ACA), the Department of Health Care Finance (DHCF) will be responsible for enforcing new provider screening and enrollment requirements. The following provides an overview of these new requirements.
Enrollment and Screening
All DC Medicaid-participating providers must be screened upon initial enrollment, including applications for a new practice location, and any applications received in response to a request for re-enrollment. Screening is also performed for a provider who is revalidated for enrollment. The required screening measures will vary according to the provider’s categorical risk level of “limited,” “moderate” or “high.”
Categorical Risk Assignments
DHCF will designate which provider types will be considered “limited,” “moderate” or “high.” “Moderate” risk provider types will be subject to general screening requirements as well as mandatory unannounced site visits. “High” risk provider types must comply with the site visits as well as background checks and fingerprints.
Re-Enrollment
All DC Medicaid providers must re-enroll every five years. Durable Medical Equipment (DME) providers will continue to be subject to mandatory re-enrollment every three years.
Application Fee
All institutional providers will be required to pay an application fee at the time of initial and re-enrollment. This requirement does NOT apply to individual physicians or non-physician practitioners or providers that are enrolled in Medicare or another State’s Medicaid program.
Disclosure of Ownership
All providers must submit a disclosure of ownership form at time of enrollment, re-enrollment and within 35 days of a change in ownership.
National Provider Identification
All claims for payment for items and services that were ordered or referred to must contain the National Provider Identification (NPI) number of the physician or other professional who ordered or referred such items or services.
Criminal Background Checks/Fingerprinting
Providers who are deemed “high” risk must complete a criminal background check and fingerprinting process within 30 days of the time they receive the request from DHCF. The provider or any persons with a 5 percent or more direct or indirect ownership interest in the provider are the ones who must adhere to the request. The ACA also gives DHCF the right to request criminal background checks and fingerprinting of any persons with a 5 percent or more direct or indirect ownership interest in the provider as stated on the Disclosure of Ownership Form.
Site Visits
Providers who are considered “moderate” or “high” risk will be required to permit DHCF staff to conduct a site visit at pre-enrollment and post-enrollment.
Enrollment of Ordering/Referring Providers
All ordering and referring providers, except those who are enrolled in risk-based Managed Care Organizations, are now required to be enrolled with the Medicaid program if they continue to order and/or refer services for Medicaid beneficiaries.
You may contact Laurie Rowe, Manager, Division of Public and Private Provider Services, Department of Health Care Finance, at 202-698-2044 or laurie.rowe@dc.gov if you have questions or would like additional information. DHCF will communicate additional information regarding these requirements over the next several months.
The Health Benefit Exchange (HBX) Operations Subcommittee was established by the Health Reform Implementation Committee in February 2012 to work on administrative and operational issues for the HBX. The subcommittee is co-chaired by the Department of Insurance, Securities and Banking (DISB) and the Department of Health Care Finance (DHCF). The subcommittee focuses on HBX financial sustainability, outsourcing and inter-agency agreements, and consumer assistance issues.
The subcommittee has been busy preparing drafts of key documents, such as the HBX Charter and By-laws, which the new Executive Board reviewed at its inaugural meeting. The subcommittee has also begun planning around the roles of District agencies engaged in carrying out HBX functions. Priorities of the subcommittee include developing an operational model for all of the HBX functions, determining the best revenue structure for the sustainability of the HBX, and adopting options and recommendations for the Navigator Program. The subcommittee will continue its work, reporting to the new HBX Executive Board.
The HBX Operations Subcommittee meets the second Tuesday of every month at DHCF at 2:00 pm. The meetings are open to the public. Check the calendar on the health reform website for up-to-date meeting information. DID YOU KNOW...?
…To date, the District of Columbia has been awarded over $9 Million by the Federal Government to plan and develop its health benefit exchange.
The due date for responses to the Health Benefit Exchange (HBX) Systems Integration RFP has been extended. Responses are now due Thursday, August 16, 2012 at 2:00 PM EDT. The RFP, which was released on July 12, and amendments including responses to bidders’ questions, are available on the Office of Contracting and Procurement website. (Search for Solicitation CW16474.) All proposal responses to the RFP must be submitted electronically through the E-Sourcing System.
The successful vendor from this competitive solicitation will design and implement the District of Columbia Access System (DCAS). DCAS will be a state-of-the-art health and human services solution, providing a new eligibility and enrollment platform, an insurance marketplace, integrated financial and plan management functionality, and enhanced case management capabilities.
The District of Columbia’s Health and Human Services agencies are still seeking candidates to work on health care reform and the District’s new health care and human services eligibility and enrollment solution.
If you are interested in the following positions in the Department of Health Care Finance, please visit the DC Jobs website for more information.
- Medicaid Program Manager (Job ID: 20032)
- Medicaid Policy Project Manager (Job ID 20033)
- Ombudsman Consumer Assistance Project Manager (Job ID 20034)
- Exchange Consumer Assistance Project Manager (Job ID 20024)
- Exchange Information and Privacy Officer (Job ID: 20028)
If you are interested in the following positions in the Department of Human Services, please send your cover letter and resume to ois.admin@dc.gov. These positions will also be posted on the Department of Human Resources website ( www.dchr.dc.gov) in the coming weeks.
- Program Analyst
- Management Analyst
- IT Specialist (Mainframe)
- IT Specialist (Application Software)
- IT Specialist (Database Manager)
AUGUST CALENDAR
Monday, August 6, 3:00 PM
Insurance Subcommittee HBX Market Working Group Meeting
Department of Insurance, Securities and Banking, 810 First Street NE, 7th Floor
Tuesday, August 7, 6:30 PM
Health Benefit Exchange Executive Board Meeting
One Judiciary Square, 441 Fourth Street NW, Room 1107
Thursday, August 9, 2:00 PM
Health Services Delivery Subcommittee Meeting
Department of Health, 899 North Capitol Street NE, Room 535
Thursday, August 9, 2:00 PM
Medicaid Expansion and Eligibility Subcommittee Meeting
Department of Human Services, 64 New York Avenue NE, 5th Floor Conference Room
Tuesday, August 14, 11:00 AM
Insurance Subcommittee Meeting
Department of Insurance, Securities and Banking, 810 First Street NE, 7th Floor
Tuesday, August 14, 2:00 PM
Exchange Operations Subcommittee Meeting
Department of Health Care Finance, 899 North Capitol Street NE, Room 6130
Wednesday, August 15, 2:00 PM
Communications Subcommittee Meeting
John A. Wilson Building, 1350 Pennsylvania Avenue NW, Room 306
Thursday, August 16, 2:00 PM
Responses to HBX Systems Integration RFP Due
Monday, August 20, 2:00 PM
Insurance Subcommittee HBX Market Working Group Meeting
Department of Insurance, Securities and Banking, 810 First Street NE, 7th Floor
Do You Have a Question about Health Reform?
Check out the Frequently Asked Questions on the health reform website. If you don't see your question, send it to healthreform@dc.gov. We will try to address it in future newsletters.
Produced by The Crider Group
|
