Washington Health Benefit Exchange Audio: 1-866-244-8528; passcode 474987 Plan Management Meeting...

Washington Health Benefit Exchange

Audio: 1-866-244-8528; passcode 474987

Plan Management MeetingNovember 19, 2013

AgendaTopic Facilitator DurationWelcome IntroductionsAgenda Review/Meeting Purpose

Susanne Towill 5 Min

Policy/Legislative UpdateUpdatesQuestion & Answer

Michael Arnis 15 Min

Provider DirectoryUpdatesQuestion & Answer

Dustin Arnette 10 Min

Monitoring and ComplianceUpdatesQuestion & Answer

Dustin Arnette 15 Min

2015 Plan Management PreparationHighlights from 2014Request for Feedback for 2015

Susanne Towill 30 Min

2015 Guidance for Participation QHP & QDPOverviewRequest for Feedback

Zach Snyder 30 Min

Next Steps / CloseNext Workgroup Meeting: January 14th, 2014 Susanne Towill 5 Min

Policy/Legislative Update Michael Arnis

Associate Policy Director

Provider Directory Dustin Arnette

Plan Manager

Provider Directory▪ Post “go-live” feedback

▪ National Provider Identifier (NPI)▪ Making this a required data field

▪ Future Enhancements:▪ Static “inbound” folder▪ Expanded search radius▪ Adding clinic name to search and results▪ Search by issuer▪ Specialty search

▪ New entrants and transition for 2015

5

Monitoring and Compliance Dustin Arnette

Plan Manager

Monitoring and Compliance

▪ Ensure ongoing compliance with certification criteria after initial certification

▪ Federal regulations applicable to operation of a State-based Marketplace (“SBM”)

▪ Additional details in the Guidance for Participation documents:▪ Section 2.4 – Monitoring and Compliance of

Qualified Health Plans (p. 17)▪ Section 2.3 – Monitoring and Compliance of

Qualified Dental Plans (p. 13)

7

QHP & QDP Compliance and Monitoring Dashboard

May 2014

Fictitious data for discussion purposes only

QHP & QDP Compliance and Monitoring Dashboard

May 2014

Full Carrier Report (excerpt)

Fictitious data for discussion purposes only

QHP & QDP Compliance and Monitoring Dashboard

May 2014

Summary of Noncompliance

Fictitious data for discussion purposes only

QHP & QDP Compliance and Monitoring Dashboard

May 2014

Complaint and Enrollment Metrics

Fictitious data for discussion purposes only

2015 Plan Management Preparation

Susanne Towill Senior Plan Manager

Reflection on 2014▪ Lessons Learned▪ Communication methods▪ Benefit data translation▪ Timeline and flow▪ Third party QA

▪ Feedback Requested▪ What worked well for you?▪ What can be improved for this year?▪ Other thoughts?

▪ Further feedback can be sent to: QHP@wahbexchange.org

Preparing for 2015

▪ Communications: ▪ Bi-Monthly Meetings▪ Alternating Bi-Monthly Newsletter▪ Plan Management Webpage refreshed

▪ Timeline & Flow▪ Coordinating drafting with federal and state requirements

▪ Guidance for Participation▪ Goal to publish drafts in December and final February 1st.

▪ CMS Data Templates▪ Providing feedback to CMS

Guidance For Participation Zach Snyder

Plan Manager

2013 QHP/QDP Guidance For Participation

17

Needed Revisions

▪ Update Regulations

▪ Plan Management Timeline

▪ Checklist

▪ Suggestions?

18