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A service of Maryland Health Benefit Exchange
Carrier Training:
Carrier Authorization and
Plan Certification
Welcome and Introductions
Overview of Carrier Authorization and Plan Certification
Carrier Administration Portal (CAP) Demo
Template review and Plan Quality import
Plan Shopping Demo
Testing process
CRISP Integration
Producer Topics
Wrap-up
2
Agenda
To keep carriers informed about key deliverables
related to carrier authorization and plan
certification
Discuss policy decisions that affect carrier
operations
Demonstrate how online tools are to be used by
carriers, state administrators, and consumers
3
Purpose of Carrier Training
Medical
• Aetna
• CareFirst
• Coventry
• Evergreen (CO-OP)
• Kaiser
• United HealthCare
Stand-Alone Dental
•Aetna Dental
•BEST Life
•CareFirst
•Coventry
•Delta Dental
•DentaQuest
•Dominion Dental
•Guardian
•Metropolitan Life
•United Concordia
4
Authorized Carriers
Maryland has adopted a strategy for 2014-2015 that allows any willing carrier to offer qualified health plans on Maryland Health Connection as long as they meet federal and state requirements. This approach will foster competition in the marketplace and help to build stability for Maryland Health Connection.
List reflects names of carriers by parent company name.
Plan Certification Workflow
Step 1
Submit Participation Intent Form
Statement of Intent to
Participate
Preliminary Information on Service Area,
Product Types, Accreditation
Status
Key Contacts for Planning & Implementatio
n
Step 2
Submit Contracts, Forms & Rates to MIA
SERFF
Licensure
Solvency
Benefits, Rates & Forms
Essential Health Benefits
Limitations on Cost Sharing
Actuarial Value/Metal Levels
Discriminatory Benefit Design
Step 3
Complete
Carrier Application
Package
Compliance with Federal
Requirements
Compliance with State
Requirements
Terms & Conditions for Participation
List of Plans
Step 4
Submit Approved Plans & Check Data to MHBE for Final
Certification
Maryland Health Connection
Carrier Administration
Portal
Required Templates
Required Attestations
Plan Shopping Data
Step 5
Provider Network Data to
CRISP
CRISP
FTP Site
Network Providers
Essential Community
Providers
Step 6
MHCC
Plan Quality & Performance
Data
Annual Custom File from MHCC
Health Plan HEDIS Scores
Health Plan CAHPS Scores
Health Plan Behavioral Health
Assessment Scores
Quality Profile
RELICC Data
April 1, 2013 May 1, 2013 July 2013 August 2013November 15, 2012 July-August, 2013
Carrier Reference Manual version 2.0
– Main policy document for Carriers
– Outlines Authorization and Certification process in detail
Plan Certification Checklist
– Contains all of the elements that will need to be
submitted and time frame in which submission will
occur
6
Tools for Carrier Authorization
and Plan Certification
In plan year one, all documents required for carrier
authorization and plan certification will be submitted via the
Carrier Administration Portal (CAP) in Maryland Health
Connection
MHBE will not be using SERFF or HIOS to send or receive
plan management documents or data
7
Carrier Administration Portal
Plans expected to be approved by the Maryland
Insurance Administration between July 1 and July
31, 2013
Carrier Administration Portal (CAP) expected to
be available to carriers by the end of July 2013
All plans must be certified by end of August 2013
so that data can go to CMS by August 31, 2013
Time Constraints
Review of the Plan Certification
Checklist
Carrier Administrator Portal
(CAP)
Process Flows
11
Carrier Registration and Application
12
State Reviews Carrier Application
13
Carrier Imports QHP Plans and Rates
14
Carrier Submits QHP Plans
15
State Reviews Plans
16
State Activates Plans
17
State Imports Quality
18
Carrier Modified Rates Mid-Plan Year
19
State Creates QHP Plans for Recertification
20
Carrier Recertifies Plans
21
State Unauthorizes Carrier
22
Carrier Appeal of Unauthorization
23
State Manages Carrier Appeal
24
State Decertifies Plan
25
Carrier Appeals Plan Decertification
26
State Manages Plan Appeal
27
State Administrator Portal Functions
28
Carrier Administrator Portal Functions
Carrier Testing Process - Update
Kick-Off – Webinar held on May 22 with all carriers to kick-off testing process– Carriers were asked to provide:
• Overall Testing Point of Contact Information
• IT Point of Contact Information (essential for connectivity testing)
• Source IP Address
• SFTP Public Key
• PGP Public Key
– MHBE has only received this information from 5 of the carriers approved to offer products through the Exchange
– Please provide POC information even if you’re not ready to begin testing at this time
Documentation – All integration documentation is available at the following:
http://marylandhbe.com/exchange-partners/plan-users/.
Updates
30
Carrier Testing Process
Tuesday - Carriers send all questions to Kerry Connolly & [email protected]– Questions received after Tuesday COB receive
response in the following week’s response cycle
Wednesday – Weekly Carrier Testing Meeting will review the list of questions and assign ownership.
Tuesday by 12PM – Noridian to provide question response to Kerry
Tuesday COB – Kerry Connolly provides response to Carriers.
Weekly Response Cycle
31
Carrier Testing Process
Points of Contact– Interface Testing Coordinator (scheduling testing, facilitation of status
meetings), Kerry Connolly, 617-939-2004(office), 603-682-2538 (mobile), [email protected]
– Interface Technical Contact (requesting access to the test environment, report defects, coordinate testing, or any other matters): Hasina Rahman. [email protected]
Next Steps– Once we have your POCs and connectivity information, we’ll send you
information on where and how to schedule a time to test.
Thank you!
Additional Information
32
Carrier Testing Process
Producer Topics
MHBE has adopted interim procedures to cover the essential steps needed for carriers to offer health plans on the Maryland Health Connection.
Part 1 Policies and Interim Procedures – Plan Certification
– Plan Recertification
– Plan Decertification
– Plan Submission Limits
Part 2 Policies and Interim Procedures– Dental & Vision Plan Offering and Price Display
– Producer Incentives
Part 3 Policies and Interim Procedures– Producer Appointments
Please refer to the Carrier Reference Manual version 2.0 for copies of all adopted interim procedures.
Interim Procedures
Interim procedures provide rules for carriers when appointing producers:– A carrier must appoint an authorized producer within 10 business days
of receipt the request
– A carrier must appoint every authorized producer • unless reasons specified under 31112(e)(1), Annotated Code of Maryland
– A carrier can not deny appointment based on production volume
– A carrier can not impose a production requirement
– A carrier must allow authorized producers to discuss all Maryland Health Connection plans with or without an appointment
– A carrier must provide a basis for denial to the authorized producer within 10 business days
– Dispute resolution will be managed by the MIA• While the dispute is being reviewed by the MIA, the producer can continue to sell
and enroll individuals and small businesses
– A carrier can limit the scope of an appointment to only Maryland Health Connection
– A carrier must provide information on their producer register upon request of the MHBE
Producer Appointments
35
Producer Appointments
Carriers will continue to be responsible for compensation of producers that sell plans on Maryland Health Connection.
Carriers will continue to develop their own models of compensation for producers.
Compensation models must not result in the disruption of consumers’ access to qualified plans, steering of consumers away from appropriate insurance offerings, or threaten the viability of Maryland Health Connection.
Carriers are expected to develop equivalent compensation and incentives for sales inside and outside of the state-based exchange.
Carriers are required to collect and maintain producer compensation data including agreements, policies, procedures, programs and other information regarding producer compensation. Carriers must provide this information to the Maryland Insurance Administration upon request.
Please refer to the Carrier Reference Manual version 2.0 to see the Exchange Board Statement of Policy on Producer Compensation.
Producer Compensation
Next Steps
Move forward with testing
Respond promptly to MIA correspondence
More information will be given regarding
– CAP Availability
– Final due dates for plan certification
Action Items / Next Steps
