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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)
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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: [email protected]
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?
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