Monthly Affordable Care Act (ACA) Webinar Series December 12, 2013

Purpose We strive to provide objective updates of useful information as the ACA moves into a key phase of implementation over the coming months. Today’s Objectives 1. Provide an update on ACA Healthcare Insurance Exchanges 2. Provide an update on ACA Healthcare Insurance Navigators and

Certified Application Counselors in Ohio. 3. Provide an update on Medicaid expansion and changes in Ohio. 4. Provide an update on healthcare system transformation activities.

(formerly Access HealthColumbus)

Today’s agenda

• Welcome & Introduction -Jeff Biehl, Healthcare Collaborative of Greater Columbus

• Update on Healthcare Insurance Exchanges -Doug Anderson, Bailey Cavalieri LLC

• Update on Navigators and Certified Application Counselors (CAC) -Isi Ikharebha, Physicians CareConnection • Update on Medicaid Expansion

-Jeff Biehl

• Update on Healthcare Delivery Transformation

-Jeff Biehl

(formerly Access HealthColumbus)

Affordable Care Act

Near Universal Insurance Coverage

Guaranteed Issue &

Insurance Mandate

Improvement Initiatives

Health Benefit

Exchanges

ACA: Key Areas of Change

By 2020… not 1/1/2014

Affordable Care Act

Near Universal Insurance Coverage

Guaranteed Issue &

Insurance Mandate

Improvement Initiatives

Health Benefit

Exchanges

New Insurance Marketplace

Effort to Bring All into Guaranteed

Insurance Marketplace

Affordable Care Act

Near Universal Insurance Coverage

Guaranteed Issue &

Insurance Mandate

Improvement Initiatives

Health Benefit

Exchanges

Expansion of Medicaid

Subsidized commercial

insurance for middle-income

families (market based)

Healthcare Insurance Exchange

Guaranteed issuance of coverage

No pre-existing condition exclusions

Premium rates cannot vary based on

health status, but only based on age and

smoking status

Subsidies for people from 100% to 400%

FPL

Key Insurance Provisions

Medicaid up to 133% of FPL

Exchanges (ie., Marketplaces)

October 1, 2013 - Open enrollment begins

December 23, 2013 - Open enrollment for coverage effective January 1, 2014 ends

March 31, 2014 - Open enrollment ends

– Coverage bought before the 15th of the month is effective the first day of the next month.

– People must buy coverage by March 31, 2014 to avoid any penalties

April 1 to November 15, 2014 – open enrollment closed

– Only special enrollments are allowed

November 15 to December 7, 2014 – open enrollment for 2015

Key Dates for Exchanges

What needs to be done by December 23rd for coverage January 1?

– Select and enroll in a health plan through Healthcare.gov or direct enroll

through an insurance company that sells coverage on the Marketplace.

– Conflicting reports about whether the premium needs to be paid by

December 23rd, or consumer can wait until January 1st.

– HHS reported that different insurers have different deadlines, and that a

consumer should contact the insurance company whose product they

purchased to determine the payment due date.

Key Dates for Exchanges

Source: Enroll America

White House gave state insurance commissioners permission to allow

consumers to keep current coverage through 2014. To keep current

coverage, the coverage must have been in

effect on Oct. 1, 2013

Consumers may also renew current coverage

in 2014 for another year. The deadline for

making such a renewal is October 1, 2014.

Ohio Department of Insurance gave companies permission to continue

coverage

Source: The Columbus Dispatch (11/28/2013)

Keeping Your Plan

Some companies in Ohio are allowing consumers to keep their current

coverage.

For the most part, current coverage which a consumer choses to keep

will stay the same, except that:

– If the coverage is renewed in 2014, it will no longer have annual limits and must

comply with federal mental health parity.

– Premium rates for the coverage may go up based on increases in medical costs.

Consumers with current coverage have choices:

– Keep their current coverage and renew it again in 2014 for another year.

– Purchase coverage subject to the ACA now.

– Keep current coverage into 2014, and purchase an ACA compliant coverage at

renewal.

Keeping Your Plan

Affordable Care Act Lawsuits

The U.S. Supreme Court will hear two cases challenging the ACA

requirement that employer’s cover contraceptives.

– These two cases about whether corporations may decide not to cover

contraceptives based on the beliefs of their owners.

– In another case, Notre Dame University challenged the requirement that it

provide contraception coverage to employees.

Other cases pending in lower courts raise the following issues:

– Whether federal exchanges may provide low income subsidies because

the federal law authorizing subsidies appears limited to state exchanges.

– Whether the employer mandate is constitutional.

We will have to wait and see. . . . .

Navigators and Certified Application Counselors (CAC)

Exchange Enrollment

0

1,000

2,000

3,000

4,000

5,000

6,000

End of October End of November

Ohio Enrollment

Ohio Enrollment

1,150

5,672

Source: The Columbus Dispatch 12/11

Certified Application Counselor Experience

Medicaid Expansion

Source: Health Policy Institute of Ohio

Where does Medicaid expansion stand?

Lawsuit challenging the legality of controlling board decision

has been expedited by the Ohio Supreme Court.

Ruling in the case is expected any day.

Medicaid Reform

SB 206, passed by the state legislator 12/4, creates a joint committee to oversee the

state's Medicaid program.

Bill seeks to limit increases in Medicaid spending and move individuals who have

other options for health care out of the program.

Republican legislators indicated more Medicaid reform bills are in the works.

Source: Record-Courier, 12/5/13

Source: Ohio Governor’s Office of Health Transformation

Benefits.Ohio.Gov

Online enrollment began on December 9th

1,165 low income Ohioians signed up for coverage on the first day.

No technical failures or glitches have been reported.

Eventually, the system will process

food stamps, welfare and other

government assistance.

Source: The Columbus Dispatch 12/9/2013

Affordable Care Act

Near Universal Insurance Coverage

Guaranteed Issue &

Insurance Mandate

Improvement Initiatives

Health Benefit

Exchanges

Shift from volume to

value-based health care

Modernize Medicaid Reform nursing facility reimbursement Integrate Medicare and Medicaid benefits Rebalance spending on long-term services and supports Create health homes for people with mental illness Restructure behavioral health system financing Improve Medicaid managed care plan performance Streamline Health and Human Services Consolidate mental health and addiction services Create a cabinet-level Medicaid department Modernize eligibility determination systems Integrate HHS information capabilities Coordinate programs for children Share services across local jurisdictions Improve Overall Health System Performance Pay for health care based on value instead of volume Encourage Patient-Centered Medical Homes Accelerate electronic Health Information Exchange

Ohio: Current Initiatives

Patient-centered medical homes Episode-based payments

Goal 80-90 percent of Ohio’s population in some value-based payment model (combination of episodes- and population-based payment) within five years

Year 1 ▪ In 2014 focus on Comprehensive Primary Care Initiative (CPCi)

▪ Payers agree to participate in design for elements where standardization and/or alignment is critical

▪ Multi-payer group begins enrollment strategy for one additional market

Year 3

Year 5

▪ State leads design of five episodes: asthma (acute exacerbation), perinatal, COPD exacerbation, PCI, and joint replacement

▪ Payers agree to participate in design process, launch reporting on at least 3 of 5 episodes in 2014 and tie to payment within year

▪ Model rolled out to all major markets

▪ 50% of patients are enrolled

▪ 20 episodes defined and launched across payers

▪ Scale achieved state-wide

▪ 80% of patients are enrolled

▪ 50+ episodes defined and launched across payers

State’s Role ▪ Shift rapidly to PCMH and episode model in Medicaid fee-for-service ▪ Require Medicaid MCO partners to participate and implement ▪ Incorporate into contracts of MCOs for state employee benefit program

5-Year Goal for Payment Innovation

Q&A