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March 2012 St@teside

Health Reform Resources

SCI keeps the Federal Reform Resources Web page ( up-to-date with the most recent information from the states, the federal government, and health policy organizations in an effort to guide our readers through the health reform implementation process. We know there are several places to go for the latest health reform resources, and we thank you for using SCI as one of your trusted sources. Here are some of the most recent resources that can be found on our Federal Reform page:

Insurance Market Reforms:

An Unwelcome Surprise: How New Yorkers Are Getting Stuck with Unexpected Medical Bills from Out-of-Network Providers
New York Department of Financial Services
This report contains the initial results of the New York Department of Financial Services investigation of surprise medical bills and how they impact New York consumers.

Actuarial Value and Cost-Sharing Reductions Bulletin
United States Department of Health and Human Services
The purpose of this bulletin is to provide information and solicit comments on the regulatory approach that the U.S. Department of Health and Human Services (HHS) plans to propose to define actuarial value (AV) for qualified health plans (QHPs) and other non-grandfathered coverage in the individual and small group markets under the ACA.

Final Rule on Risk Adjustment, Reinsurance, and Risk Corridors
United States Department of Health and Human Services
This final rule implements standards for states related to reinsurance and risk adjustment, and for health insurance issuers related to reinsurance, risk corridors, and risk adjustment consistent with the ACA.

Insurance Exchanges:

Connecticut Health Insurance Exchange RFI
Connecticut Health Insurance Exchange
The Connecticut Health Insurance Exchange has released a Request for Information (RFI) for Exchange IT and Business Processes. Responses are due March 30, 2012.

Maryland Health Benefit Exchange: Board Meeting Resources
Maryland Health Benefit Exchange
Maryland Health Benefit Exchange Board has gathered some useful materials from its latest meeting including: MOU’s with an outside research group for Level II application assistance and a take-up study; a chart outlining the handoff of exchange administration functions from the department to the public corporation; and a presentation on SHOP exchange technology enablement options.

New York: Essential Health Benefits Stakeholder Conference Call
New York State
For this presentation, consultants from Milliman, Inc. reviewed the federal guidance on essential health benefits, state options for selecting a benchmark plan, and their approach to analyzing this issue for New York.

Nevada Silver State Health Insurance Exchange Strategic Plan
Nevada Silver State Health Insurance Exchange
On March 8, 2012, Nevada's Silver State Health Insurance Exchange Board met to discuss the creation of a strategic plan.


Final Rule on Medicaid Eligibility Changes under the ACA
United States Department of Health and Human Services
The Centers for Medicare & Medicaid Services (CMS) has released final regulations on The Medicaid Program; Eligibility Changes under the Affordable Care Act of 2010 as well as an impact analysis and fact sheet on the final rule.

The Role of the Basic Health Program in the Coverage Continuum: Opportunities, Risks, and Considerations for States
Kaiser Family Foundation
This Kaiser Family Foundation brief, authored by Manatt Health Solutions, assesses the potential benefits and drawbacks to states from implementing a Basic Health Program under the Affordable Care Act (ACA). The brief discusses the potential impact of a Basic Health Program on the effectiveness of state exchanges and strategies to manage these effects. It also offers a framework for states looking to assess the financial feasibility of the Basic Health Program, highlighting key considerations in estimating the amount of federal funding they will receive and the costs of implementing the program.

Strategic Planning and Timelines:

Report on metrics for evaluation of the Colorado Health Benefit Exchange
Data Advisory Work Group of the Colorado Health Benefit Exchange
The Data Advisory Work Group (DAWG) of the Colorado Health Benefit Exchange (COHBE) released a report that describes the process used by the DAWG to select the metrics for evaluating the exchange.

Delivery System Reform:

Shared Decision Making: Advancing Patient-Centered Care through State and Federal Implementation
National Academy for State Health Policy
In this brief, the National Academy for State Health Policy (NASHP), reviewed the definition, process, and rationale for shared decision making (SDM), and the state roles in promoting SDM. The report highlights state legislative, regulatory, and other approaches in Maine, Minnesota, Oregon, Vermont, and Washington as well as the implementation challenges, policy options states have pursued, and lessons from their experience using SDM.