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AGENDA
I. Call to Order, Welcome, Roll Call, Announcements
II. Public Comment
For Possible Action
III. Approval of the minutes of the April 15, 2015 Board Meeting
IV. Executive Director’s Report
V. Legislative Update
VI. Exchange Sustainability Consideration
VII. Quarterly Budget Update
VIII. Update on Navigator Grant Awards
MEETING NOTICE AND AGENDA
Date and Time of Meeting: Thursday, June 11, 2015, 1:30 p.m.
Place of Meeting: Silver State Health Insurance Exchange 2310 South Carson Street, Suite 3A Carson City, NV 89701
Videoconference Location: Silver State Health Insurance Exchange 150 N. Stephanie St, Ste. 100 Henderson, NV 89074
Call in Number: No call in number will be available for public comment. The public may call in at (877) 402-9753 access code 2459998, which line will be available in listen only.
Web Broadcast Available at: http://exchange.nv.gov/Meetings/Watch_Live/
Meeting Materials Available at: www.exchange.nv.gov
Silver State Health Insurance Exchange
Meeting Notice and Agenda June 11, 2015
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IX. Update on Plan Certification and Management Transition
For Possible Action
X. Discussion and possible approval or direction to staff regarding the semi-annual NRS 695I.370(1)(b) fiscal and operational report to the Governor and Legislature
For Possible Action
XI. Advisory Committee Recommendations Requiring Review • Plan Certification and Management Committee
XII. Xerox Closeout Update
For Possible Action
XIII. Discussion and possible action regarding dates, times, and agenda items for future meetings
XIV. Public Comment
XV. Adjournment
Unless noted as an action item, discussion of any item raised during a report or public comment is limited to that necessary for clarification or necessary to decide whether to place the item on a future agenda.
Public comment at the beginning and end of the agenda may be limited to three minutes per person at the discretion of the chairperson. Members of the public may comment on matters not appearing on this agenda or may offer comment on specific agenda items. Comments may be discussed by the Board but no action may be taken. The matter may be placed on a future agenda for action.
Additional comment periods may be allowed on individual agenda items at the discretion of the chairperson. These comment periods may be limited to three minutes per person at the discretion of the chairperson. These additional comment periods shall be limited to comments relevant to the agenda item under consideration by the Board.
Prior to the commencement and conclusion of a contested case or quasi-judicial proceeding that may affect the due process rights of an individual the board may refuse to consider public comment. See NRS 233B.126.
All times are approximate. The Board reserves the right to take items in a different order or to combine two or more agenda items for consideration to accomplish business in the most efficient manner. The Board may remove an item from the agenda or delay discussion relating to an item on the agenda at any time. Pursuant to NRS 241.030 the Board may close a meeting to consider the character, professional competence, alleged misconduct or physical or mental health of a person. The Board may limit the internet broadcasting while in closed session but may not deliberate or take action.
We are pleased to make reasonable accommodations for members of the public who are disabled and wish to attend the meeting. If special arrangements for the meeting are necessary, please notify the Silver State Health Insurance Exchange, 2310 S. Carson St., Suite 2, Carson City, NV 89701, or call Melissa Martinez at (775) 687-9939 as soon as possible, and no later than 24 hours prior to the time of the meeting.
Silver State Health Insurance Exchange
Meeting Notice and Agenda June 11, 2015
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Notice of this meeting was posted in the following locations: Silver State Health Insurance Exchange, 2310 S. Carson St., Suite 2 Carson City, NV Fax (775) 687-9932 NV State Library and Archives, 100 North Stewart Street, Carson City, NV Fax (775)684-3311 NV State Division of Health Care Financing & Policy, 1210 S. Valley View, Las Vegas, NV Fax (702) 668-4280 NV State Department of Health and Human Services, 4126 Technology Way, Carson City, NV Fax (775) 684-4010 Southern Nevada Health District 330 S. Valley View Blvd., Las Vegas, NV Fax (702) 759-1417 State Welfare Ely District, 725 Avenue K, Ely, NV Fax (775) 289-1645 State Welfare Reno District Office, 3697-D Kinds Row Avenue, Reno, NV Fax (775) 448-5094 State Welfare Flamingo District Office, 3330 Flamingo Road, Las Vegas, NV Fax (702) 486-9401 Clark County Social Services Department, 1600 Pinto Lane, Las Vegas, NV Fax (702) 455-5950 NV State Health Division, 4150 Technology Way, Carson City, NV Fax (775) 684-4211 Legislative Counsel Bureau, 401 S. Carson St., Carson City, NV Fax (775) 684-6705 Grant Sawyer Building, 555 E. Washington Ave., Las Vegas, NV Fax (702) 486-2012 Washoe County Social Services, 350 South Center Street, Reno, NV Fax (775) 785-8648 Washoe County Library, 301 South Center Street, Reno, NV Fax (775) 327-8390 Las Vegas Urban League, 930 W. Owens, Las Vegas, NV Fax: (702) 636-9240 Notice of this meeting and supporting materials are available on or after the date of this notice at www.exchange.nv.gov or you may contact Melissa Martinez at (775) 687-9939.
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Board Meeting June 11, 2015 Roll Call LV CC Phone Absent Chair Ms. Leslie Johnstone ___ ___ _____ _____ Vice-Chair Ms. Marie Kerr, Esq. ___ ___ _____ _____
Ms. Lavonne Lewis ___ ___ _____ _____ Dr. Florence Jameson, MD ___ ___ _____ _____
Ms. Angie Wilson ___ ___ _____ _____ Ex-Officio Richard Whitley, Interim ___ ___ _____ _____ Ex-Officio Commissioner Scott Kipper ___ ___ _____ _____ Ex-Officio James R. Wells, CPA Interim ___ ___ _____ _____
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II Public Comment
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III
Approval of the minutes of the April 15, 2015
Board Meeting
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04/15/2015 SSHIX BOARD MEETING MINUTES Page 1
Silver State Health Insurance Exchange (SSHIX) Board Meeting
(DRAFT) Minutes Wednesday, April 15, 2015
Meeting Location: Silver State Health Insurance Exchange 2310 South Carson Street, Suite 3A Carson City, NV 89701
Videoconference Location: Silver State Health Insurance Exchange 150 N. Stephanie St., Suite 100 Henderson, NV 89074 Members Present Henderson: Leslie Johnstone E. Lavonne Lewis Florence Jameson, MD Carson City: Marie Kerr, Esq. Scott Kipper, Non-Voting Ex-Officio
Members Absent Judith P. Ford, MD Richard Whitley, Non-Voting Ex-Officio James R. Wells, Non-Voting Ex-Officio
Staff Members Assisting Bruce Gilbert, SSHIX Tyler Klimas, SSHIX Damon Haycock, SSHIX Cari Eaton, SSHIX Laura Rich, SSHIX Melissa Martinez, SSHIX Dennis Belcourt, DAG
I. Call to Order, Welcome, Roll Call, Announcements Chair Leslie Johnstone called the 1:30 p.m. meeting to order. Roll call was taken by
Executive Director Bruce Gilbert; a quorum was noted. There were no announcements. II. Public Comment There were no public comments at this time.
III. Approval of the minutes of the March 12, 2015 Board meeting
04/15/2015 SSHIX BOARD MEETING MINUTES Page 2
There were no questions or corrections. The following action was taken:
MOTION To approve the minutes of the March 12, 2014 Board meeting. BY: Ms. Kerr/Dr. Jameson SECOND: Ms. Lewis PASS: Unanimously
IV. Executive Director's Report Mr. Gilbert presented his report, then answered Board questions. Commissioner Kipper
provided input. V. Enrollment Update Ms. Eaton presented the report, with input by Mr. Klimas. There were Board questions
and comments, with input by Mr. Gilbert and Commissioner Kipper. VI. Legislative Update and possible Board direction or other action concerning input,
positions or recommendations on pending legislation • Assembly Bill 86, 355, 368 • Senate Bill 137 • Senate Joint Resolution 14
Mr. Gilbert presented updates on each of the above items. Ms. Johnstone requested
Mr. Gilbert to copy the Board members when something like the letter he sent regarding Assembly Bill 355 goes out; she also requested that he send us what he gave the committee. No action was taken.
VII. Update on Navigator RFA Ms. Eaton presented the report. There were Board questions and comments, with input
by Mr. Haycock and Mr. Klimas. VIII. Advisory Committee Recommendations Requiring Review Mr. Haycock presented the report. There were Board questions and comments, with
input by Mr. Gilbert. The following actions were taken: FIRST
MOTION That we revise recommendation number five to incorporate in each service area at the end of that recommendation.
BY: Ms. Lewis SECOND: Dr. Jameson PASS: Unanimously
04/15/2015 SSHIX BOARD MEETING MINUTES Page 3
SECOND MOTION That we take the staff recommendation for recommendations number
six and seven. BY: Ms. Lewis SECOND: Dr. Jameson PASS: Unanimously
IX. Status on Xerox Closeout
Mr. Haycock presented the BOS Decommissioning and the Data Transition and Retention portions of the report. Ms. Rich presented the Call Center Closeout and the Case Reconciliation and 1095A Corrections portions of the report. There no Board questions for him. Mr. Gilbert provided a comment, then answered Board questions that followed. There were Board questions.
X. Discussion and possible action regarding dates, times, and agenda items for future
meetings Items requested to be considered in the future include a follow-through on SHOP and
how the outreach is going and what we are doing to see if we can cultivate that, a continuing update on where we are with the closeout of Xerox and the reconciliation process, and a number showing how much of enrollment was done by the broker community versus the navigator community (this last item came about during public comment). There was some Board discussion, and Mr. Gilbert answered questions. No action was taken.
XI. Public Comment Lou Cila XII. Adjournment
Ms. Johnstone adjourned the meeting.
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IV Executive Director’s
Report
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AGENDA ITEM
For Possible Action
X Information Only
Date: June 11, 2015
Item Number: IV
Title: Executive Director’s Report PURPOSE The purpose of this report is to provide information to the Board and public regarding the status of the Exchange’s implementation of a state based health insurance exchange and other operational matters of the Exchange. CONTENTS PURPOSE .......................................................................................................................................... 1
CONTENTS ....................................................................................................................................... 1
GENERAL COMMENTS ...................................................................................................................... 1
GENERAL COMMENTS Exchange staff remains busy and continues to move forward on a number of projects which we have touched upon previously. While staff members will provide details on those projects, there are a number of items I think worth touching upon:
• We have received updated open enrollment numbers for the 2015 Plan Year. Our carriers report that over 60,000 of the Nevadans applying for and enrolling in health plans made payment and effectuated their insurance coverage. Nearly 90% of the consumers purchasing plans through the Exchange received advanced premium tax credits to help offset premium costs, and the average credit in Nevada reduced premiums by two-thirds, from $361.00 per month to $119.00 per month.
• We will be discussing sustainability in some detail later in meeting but we continue to have additional conversations with CMS and CCIIO in preparation for the upcoming
Executive Director’s Report June 11, 2015
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CCIIO State Exchange Group’s two-day “Workshop for Building Toward State-based Marketplace’s (SBM) Financial Sustainability” in McLean, Virginia on July 30th and 31st.
• We are also engaged in ongoing conversations about the levels of respective authority as well as efforts to identify ways in which Exchange staff and CMS/CCIIO are able to work together to best serve Nevadans. Discussions are centering on providing our Consumer Assistance Center access to the federal system to answer caller inquiries and authorizing the Exchange to assist consumers having issues with document review.
• On the legislative update front, AB86 was passed by the legislature and signed by Governor Sandoval last month. As of July 1, 2015, agents, brokers and other persons affiliated with the health insurance industry will no longer be disqualified from serving on the Board. Additionally, as of the effective date of the act, each Board member is entitled to receive a salary of $80 per day for each day or portion of a day spent on the business of the Board. This payment is in addition to the per diem and travel expenses which have historically been available to Board members while attending meetings or otherwise engaged in the business of the Board.
• We continue to await guidance from the Internal Revenue Service on the issues of required retention and purging of federal tax information and the problems posed by the architecture of the Xerox system. We had hoped to report on how these issues will ultimately resolved but there needs to be additional dialogue between the Exchange and various federal agencies as we deal with these matters.
• In preparation for the next open enrollment period, we have completed negotiations with
our Navigator groups and appeared before the Board of Examiners to gain approval of the contract with our new marketing firm, Penna Powers, who will be introduced to you at our July meeting and share their plans for the 2016 Plan Year open enrollment campaign.
We expect that we will have more information to share about many of these matters over the coming months. In the meantime, we will continue our efforts to assure that the Exchange meets the needs of and provides real value to Nevada and its citizens.
V Legislative
Update
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AGENDA ITEM
For Possible Action
X Information Only
Date: June 11, 2015
Item Number: V
Title: Legislative Update PURPOSE The purpose of this report is to provide information to the Board and public regarding Legislative Bills that may impact the Silver State Health Insurance Exchange. This report is intended to provide the Board with the ability to take a position regarding legislation that may impact the Exchange. CONTENTS PURPOSE .......................................................................................................................................... 1
CONTENTS ....................................................................................................................................... 1
ASSEMBLY BILL 86 – FILED ON BEHALF OF THE GOVERNOR ............................................................. 1
SENATE BILL 137 – INTRODUCED BY SENATOR HARDY ................................................................... 2
ASSEMBLY BILL 368 – INTRODUCED BY ASSEMBLYMAN JONES ....................................................... 2
SENATE JOINT RESOLUTION 14 – INTRODUCED BY SENATOR GUSTAVON ......................................... 2
ASSEMBLY BILL 355 – INTRODUCED BY ASSEMBLYWOMAN FIORE ................................................. 2
ASSEMBLY BILL 86 – FILED ON BEHALF OF THE GOVERNOR Activity: Passed by the legislature and signed by the Governor. Agents, brokers and other persons affiliated with the health insurance industry will no longer be disqualified from serving on the Board. Each Board member is entitled to receive a salary of $80 per day for each day or portion of a day spent on the business of the Board. This payment is in addition to the per diem and travel expenses which have historically been available to Board members while attending meetings or otherwise engaged in the business of the Board.
Legislative Update June 11, 2015
Page 2 of 2
SENATE BILL 137 – INTRODUCED BY SENATOR HARDY Activity: Section 3 of the bill which would have prohibited the purchase or sale of qualified health plans with embedded pediatric dental plans on the Exchange was deleted in committee. ASSEMBLY BILL 368 – INTRODUCED BY ASSEMBLYMAN JONES Activity: Pursuant to Joint Standing Rule No. 14.3.1, no further action allowed. SENATE JOINT RESOLUTION 14 – INTRODUCED BY SENATOR GUSTAVON Activity: Pursuant to Joint Standing Rule No. 14.3.1, no further action allowed. ASSEMBLY BILL 355 – INTRODUCED BY ASSEMBLYWOMAN FIORE Activity: A letter outlining concerns was provided to both the bill sponsor and the members of the Assembly Government Affairs Committee. Referred to Assembly Committee on Ways and Means. No further action to date.
VI Exchange
Sustainability Considerations
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AGENDA ITEM
For Possible Action
X Information Only
Date: June 11, 2015
Item Number: VI
Title: Exchange Sustainability Considerations PURPOSE The purpose of this report is to provide the Board and the public with information regarding conversations with CMS on exchange sustainability for 2017 and beyond.
CONTENTS PURPOSE .......................................................................................................................................... 1
CONTENTS ....................................................................................................................................... 1
BACKGROUND .................................................................................................................................. 1
COLLABORATING WITH CMS ........................................................................................................... 1
NEXT STEPS ..................................................................................................................................... 2
BACKGROUND On November 15, 2014, the Exchange successfully transitioned from the Xerox web portal to the Healthcare.gov technology platform for application, eligibility, and enrollment in Nevada certified Qualified Health Plans for Plan Year 2015. The Centers for Medicare and Medicaid Services (CMS) who operate Healthcare.gov informed the Exchange that there would be costs requiring Exchange payment for the use of the technology in the future. In regularly scheduled meetings in the first quarter of 2015, the Exchange was informed that a process to lease Healthcare.gov would be forthcoming in the next few months that would necessitate payment to CMS starting in Plan Year 2017. This process would be outlined in standard federal rulemaking. COLLABORATING WITH CMS In an effort to help develop the process for leasing Healthcare.gov that would work well for Nevadans, the Exchange traveled to Bethesda, MD and met with CMS Leadership on April 8,
Exchange Sustainability Considerations June 11, 2015
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2015. From the Exchange, this meeting included the Executive Director, Chief Operating Officer, Project Management Officer, Finance Officer, and the Exchange’s Board Vice-Chair. The Exchange met with the Chief Executive Officer of the Centers for Consumer Information and Insurance Oversight (CCIIO), their Deputy Director, and a cadre of financial, consumer services, and outreach federal staff. Initial conversations surrounded the lease process that Nevada, as well as any other Supported State Based Marketplace (SSBM) who exists today or will exist in the future would need to follow. CMS shared concepts but could not provide actual dollar figures or a cost methodology yet as they are still defining the inputs and outputs their technology platform and associated support would entail. It is anticipated that official guidance will come out between now and July 30 (the date of their established Sustainability Conference this year in McLean, VA). NEXT STEPS It is too early to develop appropriate plans to absorb any Healthcare.gov fees until a number (or at least an estimate) is provided to the Exchange. The Exchange has repeatedly requested information to help define this potential cost, from CMS estimated average health insurance premiums to proposed percentage allocations. The response to date has been to defer until CMS can define and finalize their proposed methodology. Similarly to the budget analysis that occurred in developing the Plan Year 2016 Per Member Per Month Fees and the State Fiscal Year 2016/2017 budget, the Exchange is poised to adjust revenues and expenditures when CMS provides the lease costs for Healthcare.gov to ensure the Exchange remains sustainable and provides more value than the Federally Facilitated Marketplace (FFM) model alternative. Staff is also actively exploring options to the Healthcare.gov platform but cannot provide any assessment of the suitability of those options until such time as pricing is provided for continuation on the federal platform. Obviously, avoiding a platform change is the best possible outcome but we will continue to collect and evaluate potential alternatives pending receipt of guidance from CMS. Given the eighteen month window implementation, the best course at this time appears to be to follow the situation closely, identify and develop potential options, and take action once all facts are known.
VII Quarterly Budget
Projections
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AGENDA ITEM
For Possible Action
X Information Only
Date: June 11, 2015
Item Number: VII
Title: Quarterly Budget Projections PURPOSE The purpose of this report is to provide the Board with an overview of the budget and the projections moving forward on both a state fiscal year and calendar year basis for the Exchange. CONTENTS PURPOSE .......................................................................................................................................... 1
CONTENTS ....................................................................................................................................... 1
BUDGET OVERVIEW ......................................................................................................................... 1
STATE FISCAL YEAR 2015 (SFY15) BUDGET .................................................................................. 2
2016/2017 BUDGET ......................................................................................................................... 2
BUDGET OVERVIEW The Silver State Health Insurance Exchange (Exchange) is funded by a combination of federal funds (grants) and Qualified Health Plan fees (Per Member Per Month - PMPM). Additionally, the Exchange, per NRS 695I, is authorized a general fund advance each fiscal year to ensure normally recurring expenses (like payroll) are paid timely while federal grant funds are requested on a reimbursable basis. That advance is paid back in full at the end of each fiscal year during the budget closing process.
Monthly Budget Projections June 11, 2015
Page 2 of 3
STATE FISCAL YEAR 2015 (SFY15) BUDGET The Exchange is currently funded by four (4) Federal grants through the end of this calendar year. No cost extensions have been submitted and approved to continue to utilize grant funds for design development and implementation (DD&I) expenses through December 31, 2015. The Per Member Per Month (PMPM) fee is also generating revenue in the form of QHP and Dental Fees. These funds are currently being utilized to pay for navigators and to build our reserves to be self-sustaining at the end of this calendar year. On a state fiscal year basis, the Exchange has expended and projected approximately 79% of the available budget through the end of the fiscal year (expires June 30, 2015). The Exchange is on track for budgetary purposes.
2511 - Balance FWD from Previous Year 524,848.00 524,848.00 - - 524,848.00 100% - 2515 - Advance from General Fund - 750,000.00 - - 750,000.00 0% (750,000.00) 3502 - Level One # 3 Establishment Grant 761,967.00 19,329.12 - 742,637.88 761,967.00 100% - 3508 - Level Two Establishment Grant 35,899,519.00 14,954,979.24 (4.98) 10,917,559.66 25,872,533.92 72% 10,026,985.08 3509 - 4th Level One Establishment Grant 4,711,172.00 833,529.79 - 1,053,184.01 1,886,713.80 40% 2,824,458.20 3510 - 5th Level One Establishment Grant 4,007,632.00 876,050.80 - 2,915,423.17 3,791,473.97 95% 216,158.03 3601 - QHP Fees 3,277,263.00 4,326,876.42 879,112.00 - 5,205,988.42 159% (1,928,725.42) 4672 - Transfer from HCFP 1,208,818.00 1,030,379.72 - 42,653.70 1,073,033.42 89% 135,784.58 TOTAL RECEIPTS/FUNDING 50,391,219 23,315,993.09 879,107.02 15,671,458.42 39,866,558.53 79% 10,524,660.47 Check - (750,000.00) - - (750,000.00) (0.01) 750,000.00
Personnel 647,075 404,867.49 37,473.10 - 442,340.59 68% 204,734.45 Out-of-State Travel 16,000 1,759.70 - 711.21 2,470.91 15% 13,529.09 In-State Travel 24,207 13,329.36 2,136.06 901.27 16,366.69 68% 7,840.31 Operating 1,043,097 102,293.89 2,904.88 1,610,111.76 1,715,310.53 164% (672,213.53) Information Tech 20,500 4,064.33 - 2,016.90 6,081.23 30% 14,418.77 Training 7,488 1,452.25 - - 1,452.25 19% 6,035.75 Navigators 1,019,279 99,352.19 - 857,218.00 956,570.19 94% 62,708.81 3rd Level One Establishment Grant 761,965 77,938.00 - 683,337.91 761,275.91 689.55
Travel 1,411 - - - - 0% 1,411.46 Contractual 610,890 - - 611,611.97 611,611.97 100% (720.59)
DWSS - Contractual 149,664 77,938.00 - 71,725.94 149,663.94 100% - 4th Level One Establishment Grant 4,711,172 1,255,918.91 - 3,130,794.89 4,386,713.80 93% 324,458.43
Operating 49,522 38,014.80 - - 38,014.80 77% 11,507.40 Contractual 2,812,951 - - 2,500,000.00 2,500,000.00 89% 312,950.71
DWSS Contractual 1,848,699 1,217,904.11 - 630,794.89 1,848,699.00 100% 0.32 5th Level One Establishment Grant 4,007,632 1,271,835.18 - 2,519,638.79 3,791,473.97 95% 216,157.76
Contractual 1,870,544 339,042.47 - 1,315,343.50 1,654,385.97 88% 216,157.53 DWSS Contractual 2,137,088 932,792.71 - 1,204,295.29 2,137,088.00 100% 0.23
Level Two Establishment Grant 36,282,530 16,703,213.43 708.84 9,744,597.19 26,448,519.46 73% 9,834,010.80 Personnel 735,499 512,288.96 - - 512,288.96 70% 223,210.04
Out-of-State Travel 39,125 11,826.64 708.84 - 12,535.48 32% 26,589.52 In-State Travel 48,368 26,153.84 - - 26,153.84 54% 22,214.16
Supplies 3,910 3,553.58 - - 3,553.58 91% 356.01 Operating 345,000 156,730.38 - - 156,730.38 45% 188,269.18
Equipment 38,546 6,231.51 - - 6,231.51 16% 32,314.12 Contractual 33,596,152 14,955,466.65 - 8,564,129.06 23,519,595.71 70% 10,076,556.34
DWSS Contractual 2,056,494 876,025.87 - 1,180,468.13 2,056,494.00 100% 0.37 GovCHA Contractual 154,936 154,936.00 - - 154,936.00 100% 0.06
DHRM Cost Allocation 5,219 5,219.00 - - 5,219.00 100% - QHP Reserve 1,313,247 - - 1,313,247.00 1,313,247.00 100% - State Wide Cost Allocation 19,517 - - - - 0% 19,517.00 GF Advance - 19,517.00 - - 19,517.00 (19,517.00) TOTAL ALL CATEGORIES 50,614,429 19,960,760.73 43,222.88 19,862,574.92 39,866,558.53 79% 10,747,870.51
Total Budget Revenue Through 05/31/15
BUDGET CURRENT REVENUE
PENDING REVENUE
PROJECTED REVENUE TOTAL REVENUE % BALANCE
OVER/UNDER
Total Budget Authority Through 05/31/15
BUDGET CURRENT EXPENDITURES
PENDING EXPENDITURES
PROJECTED EXPENDITURES
TOTAL EXPENDITURES % BALANCE
OVER/UNDER
Monthly Budget Projections June 11, 2015
Page 3 of 3
2016/2017 BUDGET The Governor’s Recommended Budget has been submitted to the Legislature for approval during session. The budget was determined by utilizing information that was available to staff during the budget building process. The Exchange presented at the first budget hearing on February 11, 2015 to the Joint Subcommittee on General Government and it was partially approved. The Exchange budget was heard again on May 2, 2015 at a joint meeting of the Assembly Committee on Ways and Means and the Senate Committee on Finance. It was presented and approved without any questions.
47,000 48,000 7,301$ 7,666$
353.37$ 371.04$ 47.66$ 50.04$
3.00% 3.00%3.00% 3.00%
RevenueFees on QHPs 5,979,020$ 6,411,545$ Fees on Dental Plans 125,262$ 138,101$ Total Revenue 6,104,282$ 6,549,646$
ExpendituresSalaries 1,240,656$ 1,241,690$ Out of State Travel 20,055$ 20,055$ In State Travel 25,000$ 25,000$ Operating 219,496$ 216,791$ Contracts 2,284,200$ 2,284,200$
Consulting 175,000$ 175,000$ Marketing 2,000,000$ 2,000,000$
Plan Certification 109,200$ 109,200$ Information Technology 13,644$ 23,510$ Training 6,523$ 6,523$ Navigators 2,200,000$ 2,200,000$ DHRM Cost Allocation 6,211$ 6,497$ Purchasing Assessment 15,143$ 15,097$ SWCAP 19,983$ 19,924$ Attorney General Cost Allocation 129,232$ 127,158$ Total Expenditures 6,180,142$ 6,186,444$
Cash ReservesFY14 Reserves 524,849$ Estimated FY15 Reserves 788,398$ Estimated FY16 Reserves (75,860)$ Estimated FY17 Reserves 363,202$ Reserves Total 1,237,387$ 1,600,588$ Days of Reserve 73 94
Projected QHP PMPM Fee ChargedProjected Dental PMPM Fee Charged
GovRec Budget - Updated Projections SFY 2016 SFY 2017
Projected Average Annual QHP EnrollmentProjected Average Annual Dental EnrollmentQHP Projected Average PremiumDental Projected Average Premium
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VIII Update on Navigator
Grant Awards
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AGENDA ITEM
For Possible Action
X Information Only
Date: June 11, 2015
Item Number: VIII
Title: Navigator Awards Update
PURPOSE
The purpose of this report is to provide information to the Board and public on the Navigator Entity awards.
CONTENTS
PURPOSE .......................................................................................................................................... 1
CONTENTS ....................................................................................................................................... 1
BACKGROUND .................................................................................................................................. 2
AWARDED ENTITIES......................................................................................................................... 2
SOUTHERN NEVADA ................................................................................................................ 2
NORTHERN NEVADA ............................................................................................................... 2
NAVIGATOR STAFFING ............................................................................................................. 2
NEXT STEPS ..................................................................................................................................... 3
Navigator RFA Update June 11, 2015
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BACKGROUND Eleven entities submitted applications by the February 25, 2015 deadline. Of these eleven entities who submitted applications, one entity withdrew their application, and one entity did not meet the requirements of the RFA at all. All applications were reviewed by a team of staff members and unanimously agreed to negotiate with those remaining nine entities. AWARDED ENTITIES Exchange staff successfully negotiated awards with all nine entities. All agreements have been signed for a May 1, 2015 start date. All of these awards are available on the Exchange website.
SOUTHERN NEVADA Academy of Human Development Asian Community Resource Center Consumer Assistance Resource Center Dignity Health - St. Rose Dominican Financial Guidance Center Foundation for Positively Kids Foundation for Recovery State of Nevada - Office for Consumer Health Assistance Three Square
NORTHERN NEVADA Financial Guidance Center Nevada Primary Care Association (Exchange Consumer Assistance Center) State of Nevada - Office for Consumer Health Assistance
NAVIGATOR STAFFING Below is a summary of the outcome of the actual negotiations for awards beginning May 1, 2015:
Agreements May 1, 2015 – January 31, 2016 Non – Open Enrollment Open Enrollment
Navigator’s South 21 41 Navigator’s North 2 4
Exchange Consumer Assistance Center 6 10 Total 29 55
% South 72% 75% % North 28% 25%
Navigator RFA Update June 11, 2015
Page 3 of 3
NEXT STEPS Exchange staff has reached out to each of the awarded entities listing the steps required for Exchange Enrollment Facilitator (EEF) training and certification. A kickoff meeting occurred on May 15th to introduce the new entities to the Exchange’s processes and answer any questions. These meetings will occur monthly and be supported by staff site visits throughout the year. As the Exchange welcomes all of the Navigator Entities, it is important to note that 8 of the 9 entities are brand new to the Exchange. Staff will continue to collaborate with the entities and tie in outreach with the Exchange’s marketing vendor.
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IX Plan Certification
Process Update
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AGENDA ITEM
For Possible Action
X Information Only
Date: June 11, 2015
Item Number: IX
Title: Plan Certification Process Update PURPOSE The purpose of this report is to provide information to the Board and public on the plan certification process for 2016. CONTENTS PURPOSE .......................................................................................................................................... 1
CONTENTS ....................................................................................................................................... 1
BACKGROUND .................................................................................................................................. 1
PLAN YEAR 2016 PLAN CERTIFICATION SCHEDULE ........................................................................ 2
PLAN SUBMISSIONS .......................................................................................................................... 2
QUALIFIED HEALTH PLANS (INDIVIDUAL) ............................................................................... 2
QUALIFIED HEALTH PLANS (SHOP) ........................................................................................ 3
STANDALONE DENTAL PLANS (INDIVIDUAL) ........................................................................... 3
STANDALONE DENTAL PLANS (SHOP) .................................................................................... 3
NEXT STEPS ..................................................................................................................................... 3
BACKGROUND During the 2014 and 2015 plan years, many of the plan management and certification functions of the Exchange were carried out by the Division of Insurance (DOI) under a Memorandum of Understanding between the Exchange and DOI. At the January Board meeting, staff announced that the Plan Certification duties would be transitioned from DOI to the Exchange due to a truncated time table for Plan Year 2016 certification and a lack of resources at DOI.
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DOI agreed to assist the Exchange during this transition year and has made staff available throughout the process. PLAN YEAR 2016 PLAN CERTIFICATION SCHEDULE The following schedule outlines the major activities for Plan Year 2016 plan certification: Activity Date(s) Status Plan Certification Webinar April 16, 2015 Complete Plans submitted to Healthcare.gov
May 15, 2015 Complete
Exchange review of plans May 15 – June 15, 2015 In Progress Plan Preview May 21 – August, 2015 In Progress Second submission of plans to Healthcare.gov
July 10, 2015 Not Yet Complete
Exchange review of plans July 10 – August 1, 2015 Not Yet Complete Final submission of plans to Healthcare.gov
August 25, 2015 Not Yet Complete
Plans Certified September 18, 2015 Not Yet Complete At this time, the Exchange is on schedule to meet all requirements for Plan Year 2016 plan certification. PLAN SUBMISSIONS The Exchange received 142 separate health and dental plans that covers all service areas throughout Nevada in both individual and SHOP marketplaces. The following tables show a high level breakdown: QUALIFIED HEALTH PLANS (INDIVIDUAL) Service Area Catastrophic Bronze Silver Gold Platinum Total* Clark and Nye Counties 4 18 24 22 1 69
Washoe County 4 20 23 18 1 66 Carson, Douglas, Storey, Lyon Counties
3 20 18 13 0 54
All other Nevada Counties 3 14 11 10 0 38
*Total plans for each service area include plans that exist in multiple service areas.
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QUALIFIED HEALTH PLANS (SHOP) Service Area Bronze Silver Gold Total* Clark and Nye Counties 2 4 4 10 Washoe County 1 1 1 3 Carson, Douglas, Storey, Lyon Counties 1 1 1 3 All other Nevada Counties 1 1 1 3 *Total plans for each service area include plans that exist in multiple service areas. STANDALONE DENTAL PLANS (INDIVIDUAL) Service Area Low Actuarial
Value High Actuarial
Value Total*
Clark and Nye Counties 9 7 16 Washoe County 9 7 16 Carson, Douglas, Storey, Lyon Counties 5 4 9
All other Nevada Counties 5 4 9 *Total plans for each service area include plans that exist in multiple service areas. STANDALONE DENTAL PLANS (SHOP) Service Area Low Actuarial
Value High Actuarial
Value Total*
Clark and Nye Counties 6 6 12 Washoe County 7 7 14 Carson, Douglas, Storey, Lyon Counties 4 4 8
All other Nevada Counties 4 4 8 *Total plans for each service area include plans that exist in multiple service areas. NEXT STEPS According to the current schedule, the Exchange’s next steps include finishing up the current round of plan reviews while preparing for the second round of plan submissions to Healthcare.gov in July. During this time until August, carriers will be viewing their plans in Plan Preview to see how their plans will be displayed on Healthcare.gov and making any applicable changes regarding how they want their plans displayed.
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X Fiscal and
Operational Report
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AGENDA ITEM
X For Possible Action Information Only
Date: June 11, 2015
Item Number: X
Title: NRS 695I.370(1)(b) Fiscal and Operational Report Report NRS 695I.370(1)(b) requires the Board “On or before June 30 and December 31 of each year, submit a written fiscal and operational report to the Governor and the Legislature, which must include, without limitation, any recommendations concerning the Exchange.” The following draft letter to the Governor and Legislature and fiscal and operational report is intended to fulfill the requirements of the statute. Recommendation Approve the letter to the Governor and Legislature and the Fiscal and Operational Report.
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June 11, 2015 Honorable Brian Sandoval State Capitol Building 101 N. Carson Street Carson City, NV 89701 Rick Combs, Director Legislative Counsel Bureau 401 S. Carson Street Carson City, NV 89701 Dear Governor Sandoval and Director Combs, NRS 695I.370(1)(b) requires the Board of the Silver State Health Insurance Exchange submit to the Governor and Legislature a written fiscal and operational report on or before June 30 and December 31 of each year. Attached for your review and use are copies of the required report. The report was reviewed and approved at the June 11, 2015 Board meeting and have been posted on the Exchange’s website at exchange.nv.gov. Please do not hesitate to contact me if you have any questions. You may also contact Bruce Gilbert, Executive Director of the Silver State Health Insurance Exchange at (775) 687-9939. Sincerely, Leslie Johnstone, Chair Silver State Health Insurance Exchange Board cc: Bruce Gilbert, Executive Director
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FISCAL AND OPERATIONAL REPORT
PROVIDED TO THE GOVERNOR AND LEGISLATURE PURSUANT TO NRS 695I.370(1)(B)
JUNE 2015 The Silver State Health Insurance Exchange is pleased to offer this Fiscal and Operational Report, required pursuant to NRS 695I.370(1)(b), to the Governor, the Legislature and the public. It provides information regarding the activities of the Exchange since January 2015 including the Exchange’s transition to a Supported State-Based Marketplace and Plan Year 2015 successful Open Enrollment efforts. CONTENTS
EXCHANGE’S TRANSITION TO A SUPPORTED STATE BASED MARKETPLACE ............................................... 1
THE BOARD ................................................................................................................................................... 2
STAFF ............................................................................................................................................................ 3
NEVADA HEALTH LINK MARKETING, ADVERTISING AND OUTREACH REPORT ........................................... 3
NAVIGATORS, ENROLLMENT ASSISTERS AND CERTIFIED APPLICATION COUNSELORS ............................... 5
FINANCE ........................................................................................................................................................ 6
FUNDING ....................................................................................................................................................... 8
ACRONYMS ................................................................................................................................................... 9
EXCHANGE’S TRANSITION TO A SUPPORTED STATE BASED MARKETPLACE Leading up to Plan Year 2015 Open Enrollment (November 15, 2014 – February 15, 2015), the Exchange transitioned to Healthcare.gov for application, eligibility, and enrollment in Marketplace plans for Plan Year 2015. In early November 2014, the Exchange re-launched NevadaHealthLink.com, an informational website that provided Nevadans with the new enrollment process on Healthcare.gov, an opportunity to participate in a pre-screener for assessment in Medicaid, Nevada CheckUp, and Qualified Health Plans on the Marketplace, a robust lookup tool for in-person assistance, and a calendar of events and activities designed to assist Nevadans with the upcoming open enrollment period. On November 14, 2014, Healthcare.gov re-launched their web portal to begin accepting applications for Plan Year 2015. NevadaHealthLink.com was connected successfully and staff tested the enrollment process from start to finish ensuring the system worked appropriately.
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Beginning November 15, 2014, Nevadans experienced a streamlined and efficient application process that guided them through the process to successfully enrol in Marketplace plans. The Exchange experienced a successful open enrollment period that ended on February 15, 2015 and a special enrollment period for Nevadans who experienced tax fines that ended on April 30, 2015. At just under 63,000, the Exchange experienced more than double the greatest level of enrollment reported in 2014 after reconciliation efforts occurred. The transition to Healthcare.gov and stabilizing the technology platform has proven to provide Nevadans a greater opportunity to enroll in the marketplace. THE BOARD In accordance with 45 CFR § 155.110(c), the State must ensure that the Exchange has in place a clearly defined governing board. The Board consists of seven voting members and three non-voting members. Of the seven voting Board members, five appointments to the Board were made by the Governor, one by the Speaker of the Nevada Assembly, and one by the Nevada Senate Majority leader. Since the last report, three Board members have moved on and one has been appointed to date to take one open seat. The current Board members are:
• Voting Members o Leslie A. Johnstone, Chair o Marie Martin Kerr, Vice-Chair o Florence Jameson, MD o E. Lavonne Lewis o Angie Wilson o Vacant (Appointed by Governor) o Vacant (Appointed by Speaker of Assembly)
• Ex-Officio – Non-voting
o Department of Administration, Jim Wells, Director o Director, Business and Industry
Scott Kipper, Commissioner of Insurance, (Director’s Designee) o DHHS, Richard Whitley, Interim Director
Since our last report there have been 5 Board Meetings. The Board, required to meet at least once a calendar quarter, currently meets on a monthly basis as directed by the Chair or majority of members (NRS 695I.340). Board Meetings are held in Carson City and Las Vegas as well as
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streamed over the internet. All Board Meetings include time for public comment, discussion for possible action items, Advisory Committee updates, Executive Director’s Report, etc. STAFF The Exchange staff currently consists of thirteen full time employees. The Chief Operating Officer, IT Officer, and Project Management Officer positions were filled internally in January 2015. An IT Analyst and Plan Management Coordinator were hired in February 2015, and a Communications Officer joined the Exchange in June 2015. Nevada has, by far, the lowest Exchange employee count in the nation. Pursuant to NRS 695I.380, all employees of the Exchange are in the unclassified service of the state. NEVADA HEALTH LINK MARKETING, ADVERTISING AND OUTREACH REPORT Nevada Health Link’s marketing and advertising campaign officially launched on November 5, 2015. Just as they did for the first open enrollment period, all marketing, advertising and outreach activities strategically aligned with our uninsured target audience, with a focus on effectively reaching young invincibles, young families, and Hispanic and African American segments. Resources for all marketing, advertising and outreach activities were aligned to the state’s geographical mix, with approximately 70% of efforts allocated to the southern part of the state and 30% allocated to the northern part of the state. Marketing and outreach activities were very aggressive during the last month of open enrollment. In addition to the original statewide media campaign and the outreach and distribution program (which have well exceeded stated goals), additional tactics were implemented to ensure everything possible was done to reach Nevadans with the details they need to sign up in time. Messaging was adjusted to reflect bold call-to-action and deadline messaging, and also to resonate specifically with young invincibles who we knew tended to wait until the last minute to act. Facebook and Twitter ads ran through February 15, 2015. They contained clear messaging about the February 15 deadline and how to sign up. January 29 was National Youth Enrollment Day, so we took the opportunity to also include messaging about the day through our Facebook presence. #YoEnroll Research-based “By the Numbers” videos were developed with the young invincible audience in mind, influencing their decision to prioritize health insurance as a “must have” opposed to a “nice to have.” This effort proved successful with tens of thousands of video views and impressions through YouTube and cable television. In the digital campaign, banner ads were rotated that counted down to February 15th (“10 Days to Enroll…,” “9 Days to Enroll…,” “Last Day to Enroll…,”). Additional billboards were placed in the same neighborhood as the Boulevard Mall, advertising
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the Enrollment Store and its location. In Reno, the outreach team was on the street “sign twirling,” ensuring drivers know we’re there and ready to help. And every single outreach activity has been focused on driving consumers to the stores. Partnering with the navigator groups, efforts were diversified by opening and/or supporting one-day, satellite enrollment events in areas other than where the stores are located; one-day events have been held at locations such as the Durango Community Center, the SSHIX office in Henderson, the Pearson Community Center (in partnership with NAACP), the Carson Community Center, and the National Bowling Stadium. The events have offered those who need help yet another opportunity to walk in and get signed up. The Get Healthy. Get Covered. Health and Enrollment Fair was the final enrollment event in Las Vegas, and was held at the Cox Pavilion at UNLV on Sunday, February 15 from 11 a.m.-7 p.m. One of the Exchange’s Navigator entities, the Ramirez Group, hosted the event and partnered with the other grantee organizations, agents and brokers, volunteers, and KPS3 to staff and run the event. Approximately 100 enrollment assisters (comprised of assisters from navigator groups, and insurance agents and brokers) were on site to help people enroll. There was also an expansive health fair, offering medical screenings and information, family activities, prize giveaways and more. With the event just down the road from the Enrollment Store (both located on South Maryland Parkway), the team had a plan in place to be able to accommodate overflow traffic between the two locations. The Reno Enrollment Store was also prepared for February 15. Overflow from the store was accommodated at a nearby Ramirez Group office, and both Reno locations were staffed by assisters from navigator groups, insurance agents and brokers, and KPS3 outreach staff. February 15 activities were heavily promoted through advertising (namely TV and radio), press releases, media interviews and every person-to-person touch point leading up to the final day. Overall Highlights for Media, Outreach and Enrollment Stores were as follows: Media Campaign Highlights
• 241 million delivered impressions total • Reached individuals 38.2 times through TV and radio ads
Outreach Campaign Highlights
• 288 events and distribution points • 521,258 touch points • 429,734 in attendance at events • 14,796 one-on-one conversations with members of our target audience • 91,524 pieces of literature distributed
Enrollment Stores & Events
• 5,981 Nevadans served
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• 2,131 QHP enrollments • 1,512 Medicaid enrollments • Successful partnerships with 3 navigator organizations, 100+ agents and brokers,
Medicaid staff and media On December 1, 2015, a Request for Proposal was posted for the procurement of a Marketing vendor and on May 12, 2015, Penna Powers was officially awarded a two year $4 million contract to continue marketing and outreach activities for the Exchange. They began work on this contract on May 13, 2015. NAVIGATORS, ENROLLMENT ASSISTERS AND CERTIFIED APPLICATION COUNSELORS Per the ACA, the Exchange must have consumer assistance functions, including a Navigator program, and must refer consumers to consumer assistance programs in the State when available and appropriate. During open enrollment and special enrollment for Plan Year 2015 (November 15, 2014 – April 30, 2015), the Exchange utilized Navigator/Enrollment Assister agreements with the following organizations:
• Ramirez Group (Statewide) • Nevada Primary Care Association (NVPCA) (Northern Nevada) • Consumer Assistance and Resource Enterprise (CARE) (Southern Nevada)
The Exchange released another round of Requests for Application (RFAs), and eleven entities submitted applications by the February 25, 2015 deadline. Of these eleven entities who submitted applications, one entity withdrew their application, and one entity did not meet the requirements of the RFA at all. All applications were reviewed by a team of staff members and unanimously agreed to negotiate with those remaining nine entities. Exchange staff successfully negotiated awards with all nine entities. All agreements were signed for a May 1, 2015 start date. All of these awards are available on the Exchange website. The following organizations were selected:
• Academy of Human Development • Asian Community Resource Center • Consumer Assistance Resource Center • Dignity Health - St. Rose Dominican • Financial Guidance Center • Foundation for Positively Kids • Foundation for Recovery • State of Nevada - Office for Consumer Health Assistance • Three Square
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FINANCE The Exchange is finalizing all remaining expenditures for State Fiscal Year (SFY) 2015 (ending June 30, 2015). The Exchange budget for SFY 2016 through 2017 was approved by the Legislature. The final 2016/2017 budget is as follows:
42 47 GL 3601Appropriations Beginning Cash QHP Fees BUDGET
GF Advance TOTAL
Revenue -$ 1,313,247$ 6,104,282$ 7,417,529$
Cat 01 Personnel -$ -$ 1,240,656$ 1,240,656$ Cat 02 Out-of-State Travel -$ -$ 20,055$ 20,055$ Cat 03 In-State Travel -$ -$ 25,000$ 25,000$ Cat 04 Operating -$ -$ 2,503,696$ 2,503,696$ Cat 26 Information Services -$ -$ 13,644$ 13,644$ Cat 30 Training -$ -$ 6,523$ 6,523$ Cat 71 Navigators -$ -$ 2,200,000$ 2,200,000$ Cat 82 DHRM Cost Allocation -$ -$ 6,211$ 6,211$ Cat 85 Cash Reserve -$ 1,237,386$ -$ 1,237,386$ Cat 87 Purchasing Assessme -$ -$ 15,143$ 15,143$ Cat 88 SWCAP -$ -$ 19,983$ 19,983$ Cat 89 AG CAP -$ -$ 129,232$ 129,232$ Cat 90 General Fund Advance -$ -$ -$ -$
Total Expenditures -$ 1,237,386$ 6,180,143$ 7,417,529$
Expenditures
Final SFY 2016 Budget
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42 47 GL 3601Appropriations Beginning Cash QHP Fees BUDGET
GF Advance TOTAL
Revenue -$ 1,237,386$ 6,549,646$ 7,787,032$
Cat 01 Personnel -$ -$ 1,241,690$ 1,241,690$ Cat 02 Out-of-State Travel -$ -$ 20,055$ 20,055$ Cat 03 In-State Travel -$ -$ 25,000$ 25,000$ Cat 04 Operating -$ -$ 2,500,991$ 2,500,991$ Cat 26 Information Services -$ -$ 23,510$ 23,510$ Cat 30 Training -$ -$ 6,523$ 6,523$ Cat 71 Navigators -$ -$ 2,200,000$ 2,200,000$ Cat 82 DHRM Cost Allocation -$ -$ 6,497$ 6,497$ Cat 85 Cash Reserve -$ 1,600,587$ -$ 1,600,587$ Cat 87 Purchasing Assessme -$ -$ 15,097$ 15,097$ Cat 88 SWCAP -$ -$ 19,924$ 19,924$ Cat 89 AG CAP -$ -$ 127,158$ 127,158$ Cat 90 General Fund Advance -$ -$ -$ -$
Total Expenditures -$ 1,600,587$ 6,186,445$ 7,787,032$
Final SFY 2017 Budget
Expenditures
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FUNDING The chart below represents the funding established for SFY15 which consists of funding from the Third, Fourth, and Fifth Level One Grants, the Level Two Grant, and revenue from Fees and Division of Health Care Finance and Policy – as of 06/01/2015.
42 47 GL 3502 GL 3508 GL 3509 GL 3510 GL 3601 GL 4672Appropriations Beginning Cash Federal Receipts Federal Receipts Federal Receipts Federal Receipts QHP Fees Transfer BUDGET Total Percent
GF Advance Est. Grant Est. Grant Est. Grant Est. Grant From DHCFP TOTAL Expended YTD ExpendedLevel One # 3 Level Two Level One # 4 Level One # 5
Revenue -$ 524,848$ 761,967$ 35,899,519$ 4,711,172$ 4,007,632$ 3,277,263$ 1,208,818$ 50,391,219$ 19,985,068$ 40%
Cat 01 Personnel -$ -$ -$ 816,153$ -$ -$ 333,557$ 9,654$ 1,159,364$ 917,156$ 79%Cat 02 Out-of-State Travel -$ -$ -$ -$ -$ -$ 16,000$ -$ 16,000$ 1,760$ 11%Cat 03 In-State Travel -$ -$ -$ -$ -$ -$ 24,207$ -$ 24,207$ 14,235$ 59%Cat 04 Operating -$ -$ -$ -$ -$ -$ 1,043,097$ -$ 1,043,097$ 104,482$ 10%Cat 26 Information Services -$ -$ -$ -$ -$ -$ 20,500$ -$ 20,500$ 4,064$ 20%Cat 30 Training -$ -$ -$ -$ -$ -$ 7,488$ -$ 7,488$ 1,513$ 20%Cat 67 Fifth Level One -$ -$ -$ -$ -$ 1,870,544$ -$ -$ 1,870,544$ 339,042$ 18%Cat 68 Third Level One -$ -$ 612,303$ -$ -$ -$ -$ -$ 612,303$ 18,543$ 3%Cat 70 Level Two Grant -$ -$ 32,682,613$ -$ -$ -$ 1,199,164$ 33,881,777$ 15,093,657$ 45%Cat 71 Navigators -$ -$ -$ -$ -$ -$ 1,019,279$ -$ 1,019,279$ 99,352$ 10%Cat 72 Fourth Level One -$ -$ -$ -$ 2,862,473$ -$ -$ -$ 2,862,473$ 38,015$ 1%Cat 73 Transfer to AG -$ -$ -$ 189,323$ -$ -$ -$ -$ 189,323$ 68,916$ 36%Cat 74 Transfer to GovCha -$ -$ -$ 154,936$ -$ -$ -$ -$ 154,936$ 154,936$ 100%Cat 75 Transfer to DWSS -$ -$ 149,664$ 2,056,494$ 1,848,699$ 2,137,088$ -$ -$ 6,191,945$ 3,104,661$ 50%Cat 82 DHRM Cost Allocation -$ -$ -$ -$ -$ -$ 5,219$ -$ 5,219$ 5,219$ 100%Cat 85 Cash Reserve -$ 524,848$ -$ -$ -$ -$ 788,399$ -$ 1,313,247$ -$ 0%Cat 88 SWCAP -$ -$ -$ -$ -$ -$ 19,517$ -$ 19,517$ 19,517$ 100%Cat 90 General Fund Advance -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ 0%
Total Expenditures -$ 524,848$ 761,967$ 35,899,519$ 4,711,172$ 4,007,632$ 3,277,263$ 1,208,818$ 50,391,219$ 19,985,068$ 40%
To Balance -$ -$ -$ -$ -$ -$ -$ -$ -$ -$
Expenditures
Current SFY 2015 BudgetAs of 06/01/2015
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ACRONYMS ACA Affordable Care Act AG Attorney General APTC Advance Premium Tax Credit Board Board of Directors of the Silver State Health Insurance Exchange BOS Business Operations Services CAC Certified Application Counselor CCIIO CMS Center for Consumer Information & Insurance Oversight CHIP Children’s Health Insurance Program CMS Centers for Medicare and Medicaid Services DHCFP Department of Health and Human Services, Division of Health Care Financing
and Policy DHHS Nevada Department of Health and Human Services DHRM Division of Human Resource Management DOI Division of Insurance DWSS Division of Welfare and Supportive Services EE Eligibility Engine EEF Exchange Enrollment Facilitator Exchange Silver State Health Insurance Exchange GF General Fund GovCHA Department of Health and Human Services, Division of Consumer Health
Assistance (formerly, the Governor’s Office of Consumer Health Assistance) HCR Health Care Reform HHS U.S. Department of Health and Human Services I-APD Initial Advanced Planning Document IT Information Technology IV&V Independent Verification and Validation NRS Nevada Revised Statute PMP Project Management Plan PMPM Per Member Per Month QHP Qualified Health Plan RAC Requirements and Configuration sessions RFP Request for Proposal RTM Requirements Traceability Matrix SFY State Fiscal Year SHOP Small Business Health Options Program UAT User Acceptance Testing
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XI Advisory Committee Recommendations Requiring Review
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AGENDA ITEM
X For Possible Action Information Only
Date: June 11, 2015
Item Number: XI
Title: Advisory Committee Recommendations Requiring Review PURPOSE The purpose of this report is to provide the Board and the public with information and recommendation regarding current Advisory Committee recommendations requiring review. CONTENTS PURPOSE .......................................................................................................................................... 1
CONTENTS ....................................................................................................................................... 1
BACKGROUND .................................................................................................................................. 1
SUMMARY ........................................................................................................................................ 1
COMMITTEE RECOMMENDATIONS .................................................................................................... 2
PLAN CERTIFICATION AND MANAGEMENT .............................................................................. 2
PLAN CERTIFICATION AND MANAGEMENT RECOMMENDATION DETAIL .................................. 3
BACKGROUND The Exchange has not reviewed the Board approved committee recommendations since the initial launch on October 1, 2013. Since that launch, the Exchange has experienced numerous successes and failures and ultimately transitioned to Healthcare.gov on November 15, 2014. With that transition, many recommendations that comprise Exchange policy are no longer valid and require review and potential replacement. SUMMARY There are currently 35 committee recommendations officially approved by the Board. An overall summary of ongoing proposed actions is as follows:
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Committee Total
Recommendations Keep As Is Change/Replace Delete
Finance and Sustainability
6 1 2 3
Plan Certification and Management
12 5 7 0
Consumer Assistance
7 0 4 3
SHOP 7 4 3 0 Reinsurance and Risk Adjustment
3 3 0 0
Total 35 13 16 6 This month, this report will discuss the Plan Certification and Management current committee recommendations approved by the Board. COMMITTEE RECOMMENDATIONS PLAN CERTIFICATION AND MANAGEMENT Number
Title Approval Date
Review Needed (Y/N)
Comments
1 Key Principles 4/12/2012 N The basic guidelines still hold true today.
2 DOI Conduct Rate Review
4/12/2012 N DOI still does rate review today.
3 Offering Same QHPs in Individual and SHOP Exchanges
9/13/2012 N The approved recommendation allows carriers to offer at their discretion. No changes needed.
4 Standardize Plan Design Cost Sharing
9/13/2012 N The recommendation is to allow carriers to create QHPs that meet the requirements of the Affordable Care Act; that the Exchange not impose any additional cost sharing requirements on QHPs. No changes needed.
5 Number of QHPs Offered by Each Carrier in a Given Tier
9/13/2012 Y Current policy says each licensed carrier be allowed to offer no more than five (5) QHPs in each metal tier (includes catastrophic tier) in each market (Individual and SHOP). Current practice
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allows each carrier to offer 5 QHPs per tier per service area. This needs to adjust to current practice.
6 Plan Certification Policy Review
12/13/2012 Y The recommendation that plan certification policies will be formally reviewed on a semi-annual basis is sound in theory. The Exchange currently reviews policies annually outside of committee. Suggest adding “and bring back to the committee if necessary.”
7 Accreditation 12/13/2012 N This recommendation addresses timelines for accreditation. No need to revise based on current requirements.
8 Network Adequacy
4/24/2013 Y DOI is the current authority on network adequacy. This can be revised to simply state that.
9 Plan Certification
1/10/2013 Y There are 5 subparts to this recommendation. Adding Standalone Dental Plan language throughout is needed and Subpart B needs to be revised as DOI no longer performs certification for the Exchange.
10 Aligning Service Areas
2/14/2013 N Service Areas are currently aligned with Rating Areas and requires no change.
11 Certification of Standalone Dental and Vision Plans
3/14/2013 Y This entire recommendation can be combined with Recommendation 9 above.
12 Standalone Dental Plan Network Adequacy
5/9/2013 N No changes needed. Exchange still determines standalone dental plan network adequacy.
PLAN CERTIFICATION AND MANAGEMENT RECOMMENDATION DETAIL RECOMMENDATION 1: KEY PRINCIPLES
• Encourage Participation • Minimize Adverse Impacts on the Exchange Market and State-Sponsored Health Care
Programs • Minimize Unintended Market Disruptions • Protect Special Populations • Monitor, Evaluate and Report Routinely • Market Facilitator • Maximize Continuity of Care
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• Improve Patient Outcomes Recommendation: Staff recommends no changes. RECOMMENDATION 2: DIVISION OF INSURANCE CONDUCT RATE REVIEW
• The DOI should conduct the rate review process as required by the ACA in a manner prescribed by the DOI.
Recommendation: Staff recommends no changes. RECOMMENDATION 3: OFFERING THE SAME QHPS IN THE INDIVIDUAL AND SHOP EXCHANGES
• Allow Carriers to offer QHPs in either or both Exchanges (Individual or SHOP) at their discretion; that QHPs not be required to be identical in the Individual and SHOP Exchanges.
Recommendation: Staff recommends no changes. RECOMMENDATION 4: STANDARDIZATION OF PLAN DESIGN COST SHARING BENEFITS
• Allow Carriers to create QHPs that meet the requirements of the Affordable Care Act; that the Exchange not impose any additional cost sharing requirements on QHPs.
Recommendation: Staff recommends no changes. RECOMMENDATION 5: NUMBER OF QHPS OFFERED BY EACH CARRIER IN A GIVEN TIER
• Each licensed carrier be allowed to offer no more than five (5) QHPs in each metal tier (includes catastrophic tier) in each market (Individual and SHOP).
Recommendation: Staff recommends adding “in each service area” to the end of the original recommendation. RECOMMENDATION 6: PLAN CERTIFICATION POLICY REVIEW
• All plan certification policies will be formally reviewed on a semi-annual basis. Recommendation: Staff recommends removing “formally” and replacing “semi-annual” with “annual” to align with the annual plan certification process. Staff with DOI guidance reviews plan certification policies each year as new information is provided by CMS. RECOMMENDATION 7: ACCREDITATION
• Require that a carrier offering a QHP must either 1) have a current accreditation by NCQA, URAC or another accreditation entity recognized by HHS or; 2) demonstrate, during QHP certification, evidence of a scheduled accreditation survey that will be
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completed within 24 months of the date of application for certification. Such accreditation must be for the product line being offered on the Exchange. A carrier that does not receive accreditation within 24 months of the date of application for certification will lose their QHP status following the completion of the plan year in which the deadline occurred. A licensed carrier that does not receive a satisfactory accreditation within the above timeline must be accredited before being allowed to sell QHPs on the Exchange. The Executive Director or Exchange Board may make exceptions to this timeline if recommended by the NCQA, URAC or the Commissioner of Insurance.
Recommendation: Staff recommends no changes. RECOMMENDATION 8: NETWORK ADEQUACY
• Recommend to the State that network adequacy standards include standards regarding telemedicine, and essential community providers. The Exchange adopts the attached network adequacy standards.
Recommendation: Staff recommends replacing the entire recommendation with the following: “The Division of Insurance, by Nevada statute, is Nevada’s authority on network adequacy for health plans. The Exchange defers this function to the Division of Insurance.” In the 2013 Legislative Session, network adequacy moved from the Health Division to the Division of Insurance and was expanded to include the entire health insurance market of Nevada. This applies to health plans only – dental plan network adequacy is addressed in Recommendation 12 below. RECOMMENDATION 9: PLAN CERTIFICATION
• The following are the Exchange’s plan certification policies for Qualified Health Plans (QHPs):
a. Any health plan that meets the requirements and standards of the Exchange, the Division of Insurance and the Affordable Care Act and its regulations will be certified as a Qualified Health Plan (QHP) to be offered on the Exchange. The requirements and standards of the Exchange may be changed by the Exchange for any future plan year. Any change to the requirements and standards of the Exchange will be communicated to the Division of Insurance, carriers and the public prior to the start of the plan certification process.
b. Request the Division of Insurance, on behalf of the Exchange, certify or recertify health plans as QHPs to be offered on the Exchange on an annual basis.
c. The Exchange will proceed with a mid-year decertification only as a result of a revocation by the DOI of a license to provide health insurance. A decertification for revocation of a license would not be appealable. The Exchange would work closely with the DOI in these cases.
d. The Exchange will set up a procedure for decertification of a QHP that will include an appeals process.
e. Pursuant to 45 CFR § 155.1000, ultimate responsibility for certification lies with the Exchange. The Exchange may, for any year after 2014, change any plan certification policy, strengthen the insurer participation standards and QHP
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standards or elect to switch to an active purchaser model. Such changes will be made in consultation with the Commissioner of Insurance and communicated to the Division of Insurance, carriers and the public prior to the start of the plan certification process.
Recommendation: Staff recommends applying the following changes:
a. Any health plan or dental plan that meets the requirements and standards of the Exchange, the Division of Insurance and the Affordable Care Act and its regulations will be certified as a Qualified Health Plan (QHP) or Standalone Dental Plan (SDP) to be offered on the Exchange. The requirements and standards of the Exchange may be changed by the Exchange for any future plan year. Any change to the requirements and standards of the Exchange will be communicated to the Division of Insurance, carriers and the public prior to the start of the plan certification process.
b. Request the Division of Insurance, on behalf of the Exchange, certify or recertify health plans as QHPs to be offered on the Exchange on an annual basis.
c. The Exchange will proceed with a mid-year decertification only as a result of a revocation by the DOI of a license to provide health insurance. A decertification for revocation of a license would not be appealable. The Exchange would work closely with the DOI in these cases.
d. The Exchange will set up a procedure for decertification of a QHP that will include an appeals process.
e. Pursuant to 45 CFR § 155.1000, ultimate responsibility for certification lies with the Exchange. The Exchange may, for any year after 2014, change any plan certification policy, strengthen the insurer participation standards, SDP and QHP standards or elect to switch to an active purchaser model. Such changes will be made in consultation with the Commissioner of Insurance and communicated to the Division of Insurance, carriers and the public prior to the start of the plan certification process.
Adding Standalone Dental Plan language will allow for the removal of Recommendation 11 below. Additionally, removing Subpart B aligns current practices for plan certification today. RECOMMENDATION 10: ALIGNING SERVICE AREAS
• Align the service areas for Qualified Health Plans with the rating areas developed by the Division of Insurance and approved by the Center for Consumer Information and Insurance Oversight (CCIIO). The Exchange will review the services areas once they are approved by CCIIO.
Recommendation: Staff recommends no changes. RECOMMENDATION 11: CERTIFICATION OF STANDALONE DENTAL AND VISION PLANS
• The standards outlined in the March 14, 2013 document, Certification of Standalone Dental and Vision Plans apply to pediatric dental, adult dental and adult vision.
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• The Exchange will not require any type of accreditation for plan year 2014 for dental and vision plans. Staff will return to the Board with recommendations for plan year 2015.
• All QHPs that provide the pediatric dental essential health benefit will separate the pricing out from the remainder of the health plan by submitting the dental benefit as a rider for that product.
Recommendation: Staff recommends eliminating this recommendation if the Board approves the consolidation of Standalone Dental Plans and QHPs in Recommendation 9 above. Per the ACA, vision plans cannot be separated from QHPs. RECOMMENDATION 12: STANDALONE DENTAL PLAN NETWORK ADEQUACY
• Adopt the attached network adequacy standards for standalone dental plans. Recommendation: Staff recommends no changes.
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XII Update on Xerox
Closeout
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AGENDA ITEM
For Possible Action
X Information Only
Date: June 11, 2015
Item Number: XII
Title: Update on Xerox Closeout PURPOSE The purpose of this report is to provide information to the Board and public on updates to the Xerox Closeout activities. CONTENTS PURPOSE .......................................................................................................................................... 1
CONTENTS ....................................................................................................................................... 1
DATA TRANSITION AND RETENTION ................................................................................................ 1
CALL CENTER CLOSEOUT ................................................................................................................ 2
CASE RECONCILIATION AND 1095A CORRECTIONS ......................................................................... 2
CONCLUSION .................................................................................................................................... 2
DATA TRANSITION AND RETENTION In early May, the Exchange reviewed responses to the Data Storage RFP and decided to develop an in-house cost-effective storage solution that meets all CMS and IRS requirements. The Exchange is currently procuring hardware and software to complete this process. The IRS canceled both scheduled meetings that were dedicated to finalizing the FTI data transfer and purge requirements for the BOS. Without current guidance, the Exchange is moving forward with current planning efforts and expects Plan Year 2014 data transfer from Xerox by June 30, 2015. The Exchange participated in a demo of the 1095A Form correction application built by Natoma and the process appears to be simple and effective. The Exchange is confident that once data is
Update on Xerox Closeout June 11, 2015
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transferred by Xerox, staff will be able to produce corrected 1095A Forms to Nevadans and associated reporting to the IRS. CALL CENTER CLOSEOUT On April 15, 2015, Xerox ceased operations of their call center. The toll-free number was transferred to the Exchange’s Consumer Assistance Center that evening and the Exchange took over receiving calls on April 16, 2015. Additionally, the Exchange has taken over the Post Office Boxes in Southern Nevada and has begun processing correspondence. CASE RECONCILIATION AND 1095A CORRECTIONS The Exchange is still working with Xerox and all carriers on Plan Year 2014 consumer issues. All changes made in the BOS to reflect 1095A Form corrections finalized on April 30, 2015. The financial system tied to the BOS made final adjustments and Xerox will submit a final round of corrected 1095A Forms to Nevadans targeted the first week of June. After that final round, no corrected 1095A Forms will be provided until the Exchange receives the data transfer from Xerox and produces those forms ourselves. The Exchange anticipates having this functionality in July 2015. Although Xerox has provided a resource to the Exchange to assist Nevadans who call our Consumer Assistance Center with questions and requests, we have been advised that – contrary to our expectations - necessary changes to their accounts (1095A form corrections, effective dates of coverage, etc.) can not be made until the Exchange takes ownership of the Plan Year 2014 data. Xerox initiated a data freeze on April 30 and the planned transfer of that data by June 30 meant there is a 60-day window (at a minimum) where Nevadans cannot receive help with Plan Year 2014 issues. The Exchange approached Xerox and reiterated the need for their assistance with Nevadans and requested an expedited plan. Xerox reiterated their original closeout plan that did not address these critical issues. Since Xerox holds all the data to date, only Xerox can make adjustments to that data. Those adjustments were needed to solve the outstanding issues. The Exchange has reached out to our federal partners for assistance to assure Nevada consumers are not penalized by this failure. CONCLUSION This report concludes the operational closeout of Xerox. The final activity remaining is the complete transfer of Plan Year 2014 data that is supposed to occur between June 15 – June 30.
