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January 2013 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

QHP Issuer Certification Checklist
State Health Reform Assistance Network
The Qualified Health Plan (QHP) Issuer Certification Checklist, developed by Georgetown University’s Health Policy Institute, can be used or modified for use by insurance regulators (and/or exchanges) in reviewing applications filed by carriers for approval as QHP issuers. This checklist provides an outline for insurance regulators to ensure that carriers that seek to become QHP issuers are in compliance with Affordable Care Act requirements.

Implementing New Private Health Insurance Market Rules
Kaiser Family Foundation
This brief examines the three proposed federal regulations that detail how the ACA’s rules will operate in private insurance market reforms, essential health benefits and actuarial value, and wellness programs offered or required by employers under group health plans. These regulations deal with aspects of the ACA intended to promote broader risk pooling, prohibit discrimination based on health status, enhance insurance market efficiency and affordability, promote wellness, and improve consumer protections. 

Insurance Exchanges

Premium Collection in State-Based Exchanges
State Health Reform Assistance Network
This issue brief, prepared by Manatt Health Solutions, summarizes federal policy guidance and outlines requirements, options and key considerations for state-based exchanges (SBEs) on exchange premium collection functionality. Exchanges organized pursuant to the Affordable Care Act (ACA) have certain requirements and several options for premium collection services for small businesses and individual consumers purchasing qualified health plans (QHPs) in 2014. This brief explores the policy and operational considerations that SBEs face related to the three options for premium collections functionality.

Regional Connector Entities Grant Solicitation
Maryland Health Benefit Exchange
The Maryland Health Benefit Exchange has released a grant solicitation for applicants interested in serving as regional entities in its Connector Program.  The Connector entities will consist of navigators licensed by the Maryland Insurance Administration and non-certified assisters. The grants will cover the time period from July 1, 2013, to June 30, 2014, with three additional one-year renewal options available.

Nevada’s Plan Certification, Recertification, and Decertification
Silver State Health Insurance Exchange
Nevada’s Silver State Health Insurance Exchange presented this report to its board to assist in determining the proper procedures and methods for plan certification, recertification and decertification, in addition to offering component plan certification recommendations.


Hard Work Streamlining Enrollment Systems Pays Dividends To The Sooner State
Health Affairs
In this article, Alice Weiss examines Oklahoma’s efforts to streamline and modernize Medicaid enrollment. Oklahoma is the only state so far to implement an online application system for Medicaid, and its automated eligibility determination system for Medicaid is among the most modern and efficient nationwide, with the state is expected to achieve a nearly three-to-one return on its investment in 2015.

Health Home Core Quality Measures
Centers for Medicare and Medicaid Services
In this letter to State Medicaid Directors, the Centers for Medicare and Medicaid Services (CMS) provides recommendations for the core set of health care quality measures to be used for assessing the health home service delivery. While CMS is not requiring states to use these measures until the final regulations are released, this core set was released to help guide states as they consider the design and implementation of their health home programs.

Getting into Gear for 2014: Findings from a 50-State Survey of Eligibility, Enrollment, Renewal, and Cost-Sharing Policies in Medicaid and CHIP, 2012–2013
Kaiser Family Foundation and Georgetown Center for Children and Families
Federal regulations released in 2012 outline the requirements for all Medicaid programs to have Web-based, paperless, real-time enrollment processes that will rely on electronic data and minimize administrative burdens on individuals and eligibility workers. As of January 1, 2013, 47 states had applied for or received increased federal funds to make major upgrades to Medicaid enrollment systems, and 42 states had already begun their system development work. This survey provides a snapshot of Medicaid and CHIP enrollment and eligibility policies and procedures and highlights the changes that states will need to make in their programs to prepare for the ACA in 2014.

Financial Sustainability of Medicaid and Exchange Integrated Eligibility Systems: State Cost Allocation Methodologies
State Health Reform Assistance Network
Through a review of Implementation Advance Planning Documents/Implementation Advance Planning Document Updates (IAPD/IAPDU) from California, Massachusetts, Minnesota, Nevada, Oregon and Rhode Island, this brief and its companion chart, prepared by Center for Health Care Strategies, analyzes various cost allocation methodologies that can be used by other states to develop suitable methodologies for ACA-compliant eligibility systems integration efforts. The brief also provides examples of strategies used for validating and tracking costs included in the cost allocation plans. The models analyzed offer insights to aid states in developing appropriate methodologies that efficiently allocate costs, maximize federal contributions, and ensure the long-term financial sustainability of the Exchange, Medicaid and other human service programs.

Strategic Planning

Coordination of Human Service Programs with Health Reform Implementation
Center for Budget and Policy Priorities
The Center for Budget and Policy Priorities released a toolkit that aims to help states coordinate their health reform activities with other human service programs. It is designed to help states develop eligibility and enrollment systems and processes that not only meet ACA standards, but also enable enrollees (primarily poor and near-poor families) to access all of the benefits available to them through other programs.

Delivery System Redesign

Confronting Costs: Stabilizing U.S. Health Spending While Moving Toward a High Performance Health Care System
The Commonwealth Fund
The Commonwealth Fund Commission on a High Performance Health System analyzed a set of synergistic provider payment reforms, consumer incentives, and system-wide reforms to confront costs while improving health system performance with the goal of holding increases in national health expenditures to no more than long-term economic growth. The recommended approach could slow spending by a cumulative $2 trillion by 2023—if begun now with public and private payers acting in concert.