The Health Benefit Exchange (HBX) Executive Board met on September 5 and September 24. Key agenda items at the September 5 meeting included a presentation on the Exchange Operational Business Model, discussion of the Exchange Policy and Operational Timeline, overview of proposed board committees, and an overview of the Exchange's procurement policies and procedures. The September 24 meeting included a presentation and public comments on the proposed Essential Health Benefits for the District as well as a presentation on the process for obtaining federal certification of the DC HBX. Minutes from these meetings can be found here on the District's health reform website.
The next meeting of the HBX Executive Board will be on Wednesday, October 3, from 5:30 - 8:00 PM at the Department of Health, 899 North Capitol Street NE in Room 406. The agenda items for this meeting include a presentation on the Strategic Communications Plan and updates from the Board Working Committees.
See related stories about Essential Health Benefits, HBX Working Committees, and the HBX Interim Executive Director in this newsletter.
Sandra Robinson has been selected to serve as the Interim Executive Director for the DC HBX while a national search is conducted for the permanent position. Ms. Robinson is currently the Chief Operating Officer for the District of Columbia Department of Health (DOH), where she oversees the day-to-day operations of a vast array of agency functions for one of the District’s largest agencies.
Previously she served as Deputy Director for Operations for the Community Health Administration within DOH. She has worked for the District government since 1998. Ms. Robinson worked for several management consulting firms based in New York City and Washington, DC prior to joining the District government. She received Bachelor of Science degrees in Political Science and Economics from Macalester College in St. Paul, Minnesota and a Master of Science degree in Project Management from the George Washington School of Business. She also completed the Senior Executive in State and Local Government Program at the John F. Kennedy School of Government at Harvard University.
The Executive Director for the DC HBX will be responsible for managing, administering, developing and carrying out the goals and objectives of the HBX. The full job description for the HBX Executive Director position can be found here on the DC Human Resources website. Interested qualified candidates are encouraged to apply.
Four working committees, each chaired by a HBX Executive Board member, have been established to address the wide range of issues and activities facing the Exchange Authority. The following lists each working committee, its subject matter areas, and the HRIC Subcommittees that now report to it:
Business Operations Working Committee
Chair: Diane Lewis
Subcommittees: Exchange Operations Subcommittee and Health Delivery System Subcommittee
Legislative Study Areas: Feasibility and desirability of the Authority to engage in selective contracting, multi-state contracting and entering into a regional exchange and how the Authority will ensure financial integrity in compliance with the ACA.
The Insurance Market Working Committee
Chair: Kevin Lucia
Subcommittee: Insurance Subcommittee
Legislative Study Areas: The rules under which health benefit plans should be offered inside and outside the Exchange to mitigate adverse selection and encourage enrollment in the Exchange and the design and function of the Small Business Health Options Program (SHOP) Exchange beyond the requirements of the ACA to promote quality, affordability and portability.
IT Infrastructure and Eligibility Working Committee
Chair: Dr. Leighton Ku
Subcommittees: IT Subcommittee and Medicaid Expansion & Eligibility Subcommittee
Legislative Study Areas: N/A
Marketing and Consumer Outreach Working Committee
Chair: Kate Sullivan
Subcommittee: Communications Subcommittee
Legislative Study Areas: The design and operation of the Authority’s Navigator Program and any other appropriate consumer-assistance mechanisms and how the Authority should conduct its public relations and advertising campaigns.
The HRIC Insurance Subcommittee finalized its recommendation for the Essential Health Benefits (EHB) plan to be offered by plans in the District. The benchmark plan most consistent with federal requirements is BlueCross BlueShield CareFirst Blue Preferred Option 1. FEDVIP pediatric dental and vision benefits were added to meet the pediatric benefit requirements.
The ACA requires that the EHB cover these ten areas of services:
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Ambulatory patient services
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Emergency services
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Hospitalization
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Maternity and newborn care
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Mental health and substance abuse
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Prescription drugs
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Rehabilitation and habilitative services
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Laboratory services
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Preventive and wellness services
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Pediatric dental and vision services
In establishing an EHB benchmark, the District considered ten benchmark plans per federal guidance: the three largest enrollment plans in the Federal Employee Health Benefits Program, the three largest plans for District employees, the three largest District small group plans and the largest HMO offered in the District.
The work to identify the EHB benchmark plan began late last year when the Department of Insurance, Securities and Banking (DISB) solicited benchmark information from carriers serving the District. Analyses of these data by DISB and an outside consultant resulted in the August 2012 release of the "Essential Health Benefits Bulletin," a document with a proposed benchmark insurance plan. The bulletin is posted on the District's health reform website. The public was invited to review the bulletin and provide comments through September 28.
The Insurance Subcommittee established several guiding principles for determining the benchmark insurance plan: the plan should include District mandates, provide the benefits in most, if not all, ten EHB benefit categories and provide consumers with a baseline benefits package to meet the most universal health care needs.
Once finalized, the EHB recommendation must be submitted by DISB to the Center for Consumer Information and Insurance Oversight (CCIIO) at the US Department of Health and Human Services (HHS) for final approval.
Members of the DC HBX Executive Board and several staff attended an Exchange Leadership Event, sponsored by the Center for Health Information and Decision Systems of the Robert H. Smith School of Business at the University of Maryland on September 19-21. The meeting was held at The Gaylord National Resort and Convention Center at National Harbor. The event gave attendees the opportunity to learn from experts about key aspects of exchanges and to interact with leaders from other states that are progressing in implementing state based exchanges.
Sessions over the two-day program addressed important issues, such as achieving financial sustainability; establishing the technology infrastructure for health insurance exchanges; exchange operations, call centers and project management; tying the exchange together with a Customer Relationship Management (CRM) framework; and communication strategies supporting exchange implementation.
The District has been awarded a Level Two Establishment Grant for $73 million for the continued development of the District’s Health Benefit Exchange (HBX). The multi-year grant is awarded to states further along in building their exchanges. The District’s Level Two Grant funding will be used to develop the IT infrastructure, operations, and education and outreach activities to support the required functions of the District’s HBX.
“The District has been at the vanguard in terms of implementing health care reform. The $73 million grant award demonstrates our significant progress towards the implementation of a health benefit exchange as required by the federal Affordable Care Act, and will provide us with the resources necessary to bring quality, affordable health care insurance to District residents,” said Mayor Gray.
Thus far, the District has received over $82 million in federal grant funds for the HBX. In 2011, the District received a Planning Grant for nearly $1 million followed by an $8.2 million Level One Exchange Establishment Grant. The Level Two grant provides funding through 2014.
“I am grateful for the federal decision to award us the Level Two Grant,” said Dr. Mohammad Akhter, Chair of the District’s HBX Authority. “This grant provides us the necessary resources to continue our efforts to create a robust Health Benefit Exchange that will offer affordable health insurance to all District residents.”
The HBX Authority press release announcing the grant is on the health reform website.
The Affordable Care Act requires each health insurance exchange to establish a Navigator Program to provide education, outreach and enrollment assistance to potential exchange participants. The Department of Health Care Finance contracted a consultant to prepare a report analyzing options and offering recommendations for the District's Navigator Program. The HRIC Exchange Operations Subcommittee is inviting the public to submit written comments on the report.
The Affordable Care Act requires exchanges to be certified by HHS by January 1, 2013. CCIIO issued a blueprint for states to follow to get approval of their health insurance exchanges. The guidelines provide three options for exchange models (state-based, partnerships or federally facilitated). The District is establishing a state-based model.
HHS will approve a state’s exchange based upon submission of a blueprint application, which is due to CCIIO by November 16, 2012. The blueprint is to be made up of two components: a declaration letter and the exchange application. The application must address how the state will meet or intends to meet the specific requirements for a state-based exchange. The activity areas and requirements are summarized below:
Legal Authority and Government
There must be legislation or regulations to operate an exchange, including a Small Business Health Options Program (SHOP) and a governance structure that complies with the ACA.
Consumer and Stakeholder Engagement and Support
Stakeholder consultation is required, and there must be programs to provide effective outreach and educational materials, a Navigator Program, a Call Center, and in-person assistance for participants in the exchange.
Eligibility and Enrollment
A single, streamlined application must be used for Medicaid and the HBX eligibility, and the exchange must be able to calculate subsidies and cost-sharing to which applicants are entitled and handle eligibility and financial determinations and appeals securely and accurately.
Plan Management
There is a process for determining which Qualified Health Plans (QHPs) can participate in the exchange as well as fair policies and procedures for monitoring and removing plans, when justified.
Risk Adjustment and Reinsurance
Risk adjustment and reinsurance programs must be set up to help spread risk and reduce uncertainty for plans in the exchange.
Small Business Health Options Program (SHOP)
The SHOP must be compliant with the business size and participation requirements in the ACA and be able to aggregate premiums and electronically report required SHOP data to the IRS.
Organization & Human Resources
The organizational structure and staffing resources must be sufficient to perform exchange activities.
Finance & Accounting
A long-term operational cost, budget, and management plan must be developed to address, track and monitor projected revenues and expenses.
Technology
The exchange must have adequate technology infrastructure and bandwidth to comply with federal requirements and to support exchange ,functions.
Privacy and Security
Privacy and security policies and procedures, safeguards based on HHS IT guidance, and safeguard protections for federal information must be in place.
Oversight, Monitoring and Reporting
Routine oversight and monitoring of exchange activities must be established with adequate data collection in place to measure performance and outcomes. Accounting, reporting and auditing procedures must also be in place to ensure the financial integrity of the exchange.
Contracting, Outsourcing
Appropriate contracts and agreements must be executed with all vendors and local and federal agencies for needed exchange activities and functionality.
States that do not meet all requirements by the application deadline will receive conditional approval and will continue to work with CCIIO and submit required documentation until fully approved.
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.
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Medicaid Program Manager (Job ID: 20032)
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Medicaid Policy Project Manager (Job ID 20033)
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Ombudsman Consumer Assistance Project Manager (Job ID 20034)
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Exchange Consumer Assistance Project Manager (Job ID 20024)
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Exchange Information and Privacy Officer (Job ID: 20028)
If you are interested in the following position in the Department of Human Services, please send your cover letter and resume to ois.admin@dc.gov.
Check out the General Frequently Asked Questions and Small Business Owners and Producers 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.
Wednesday, October 3, 5:30 PM
Health Benefit Exchange (HBX) Executive Board Public Meeting
Department of Health, 899 North Capitol Street NE, Room 406
Wednesday, October 10, 2:00 PM
HRIC Communications Subcommittee Meeting
John A. Wilson Building, 1350 Pennsylvania Avenue NW, Room 306
Thursday, October 11, 10:00 AM
HRIC Medicaid Expansion and Eligibility Subcommittee Meeting
Department of Human Services, 64 New York Avenue NE, 5th Floor Conference Room
Thursday, October 11, 2:00 PM
HRIC Health Delivery Subcommittee Meeting
Department of Health, 899 North Capitol Street NE, Room 535
Monday, October 15, 3:00 PM
HRIC Insurance Subcommittee Insurance Market Working Group Meeting
Department of Insurance, Securities and Banking, 810 First Street NE, 7th Floor
Wednesday, October 17, 5:30 PM
Health Benefit Exchange (HBX) Executive Board Public Meeting
John A. Wilson Building, 1350 Pennsylvania Avenue NW, Room 407
Thursday, October 18, 2:30 PM
HRIC Exchange Operations Subcommittee Meeting
Department of Health Care Finance, 899 North Capitol Street NE, Room 6130
Wednesday, October 24, 2:00 PM
HRIC Communications Subcommittee Meeting
John A. Wilson Building, 1350 Pennsylvania Avenue NW, Room 306
Wednesday, October 31, 5:30 PM
Health Benefit Exchange (HBX) Executive Board Public Meeting
John A. Wilson Building, 1350 Pennsylvania Avenue NW, Room 407
Wednesday, November 7, 5:30 PM
Health Benefit Exchange (HBX) Executive Board Public Meeting
John A. Wilson Building, 1350 Pennsylvania Avenue NW, Room 407
Thursday, November 8, 10:00 AM
HRIC Medicaid Expansion and Eligibility Subcommittee Meeting
Department of Human Services, 64 New York Avenue NE, 5th Floor Conference Room
Thursday, November 8, 2:00 PM
HRIC Health Delivery Subcommittee Meeting
Department of Health, 899 North Capitol Street NE, Room 535
Produced by The Crider Group
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