State Legislators Check List for Health Reform Implementation

8/7/2019 State Legislators Check List for Health Reform Implementation

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The 2011 State Legislators Check List for Health Reform Implementation

DECEMBER 2010

Rachel Morgan RN, BSN, Health Committee Director

National Conference of State Legislatures 444 North Capitol Street, N.W., Suite 515 Washington, D.C. 20001


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State Legislato

tional Conferen

PLOYEE BENEF

s Check List for

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IT CHANGES ......

Health Reform I

atures

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mplementation

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Health Benefits E

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PLANNI

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LINK TO

mplementation

NG FOR STATE EXCHA

fordable Care Act

ual market, and t

states to establis

ment or nonprofi

stsharing credits.

made by state legi

UIDANCE TO STATES

partment of Healt

xchanges. The sec

st states and territ

a series of docum

cument cover the

inciples and Priorit

tline of Statutoryrifications and Po

deral Support for

changes have bee

all business shop

s and services, an

INITIAL GUIDANCE D

NGE IMPLEMENTATIO

(ACA) establishes

o provide options

and implement t

entities will certi

States have seve

slators or depend

ON EXCHANGES

h and Human Serv

etary plans to rel

ories with their ov

nts that will be re

following:

ies

Requirementslicy Guidance, and

he Establishment

defined as a mec

or coverage in a

d quality.

CUMENThttp://

N IN FY2014

a plan to facilitate

for small busine

e operation of an

ying plans and id

al options to stru

nt upon actions t

ices released guid

ase regulations fo

erall planning, incl

leased by HHS ov

of State based exc

hanism for organi

ay that permits e

ww.ncsl.org/doc

the purchase and

s through Ameri

exchange no late

ntify individuals e

ture their exchan

ey take in session

ance November 1

r public comment

uding the legislati

r the next three y

hanges.

ing the health ins

sy comparison of

uments/health/11

sale of qualified

an Health Benefi

than January 1, 2

ligible for Medicai

ges and many of t

from 2011 throug

thto assist states i

in 2011, but has p

e plans for 2011.

ars. The categori

rance marketplac

available plan opti

18ExchGuid.pdf

6

ealth coverage in

Exchanges. The

014. Stateestablis

d, CHIP, and prem

hese decisions wil

h to 2014.

n the developmen

ovided this guida

his guidance is th

s of information i

e to help consume

ons based on pric

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tional Conferen

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HEALTH BENEFITS EX

IN

PROGRESS

CO

xchange is defin

s Check List for

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CHANGES

PLETED IMPLEME

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FY2011

d as meaning the

Health Reform I

atures

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Actions PLANNIN

LEGISLAT

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2.

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If tthe

be

Du De Co Gra

to

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mall Business He

mplementation

G FOR STATE EXCHAN

IVE CONSIDERATIONS

te options for con

Designation of th

a new or exi an independ

Whether to estab

Whether to opera

market.

ermine governana governing board

determine the pr

designation of co

licensure require

e state exchange

Department of H

efits in relation to

ies of the exchan

ignate state auth

form all state law

nt necessary rule

xchanges.

ermine budget fo

roperability requi

sion 1.00).

lth Options Progr

GE IMPLEMENTATION

[Based on recom

ideration relating

oversight authori

ting state agency,

ent public agency,

lish a regional or in

te a unified excha

e mechanisms if t, its size, composi

cess of appointm

mittees or other

ents.

will require certai

alth and Human S

premium and cos

e.

rity responsible f

to Federal ERISA f

making authority t

exchange, Medic

rement, (refer to r

m.

IN FY2014 (contin

endations from t

to exchange struc

ty within:

or

or quasigovernm

terstate exchange

ge by merging th

e exchange is nottion and terms,

nts to the board,

entities involved i

health benefits t

ervices. (States m

sharing assistanc

r health benefit pl

iduciary duties.

o appropriate stat

id, and CHIP infor

esource documen

ed)

he NAIC model ac

ure:

ental agency,

, and

SHOP Exchange1

located within a s

heir powers and

daytoday respo

at exceed the ess

st develop a mech

e for enrollees.)

an certification.

e entities responsi

mation technolog

s, Guidance for E

t]

and the exchange

tate agency includ

uties,

nsibilities, and

ential benefits pac

anism to defray t

ble for implement

systems needs ca

change and Medi

7

for the individual

ing:

kage established b

e cost of addition

ing state law relat

pable of meeting

caid IT Systems,

y

l

d


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tional Conferen

ASKS

HEALTH BENEFITS EX

IN

PROGRESS

CO

s Check List for

e of State Legisl

CHANGES

PLETED IMPLEME

DA

FY2011

Health Reform I

atures

NTATION

TE

Actions GUIDAN

Accordi

functio

exchan

particip

Service

I. EXC

mplementation

E FOR STATUTORY RE

ng to the ACA ther

s exchanges must

es must exercise i

ating in the excha

Act.

HANGE FUNCTIONS

Core functions t

1. Certification2. Operation o3. Maintenanc4. Assignment5. Presentation6. Provision of

these progra

7. Provision offor premium

8. Certification9. Provision of10. EstablishmeAdditional Excha1. Presentation2. Provision for3. Consultation4. Publication

QUIREMENT (BASED

e are two basic ty

undertake directl

n certifying and m

ges must also co

at an exchange m

recertification an

a tollfree hotline

of a website for

f a price and qual

of plan benefit o

information on M

ms,

an electronic calcu

tax credits and co

of individuals exe

information on ce

t of a Navigator p

nge functions inclof enrollee satisf

open enrollment

with stakeholders

f data on the exch

N HHSGUIDANCE R

es of federal requ

or, in some cases

onitoring the perf

ply with state ins

ust meet:

d decertification o

,

roviding informat

ity rating to plans,

tions in a standar

dicaid and CHIP el

lator to determin

st sharing reducti

pt from the indiv

tain individuals an

rogram that provi

ude:ction survey resul

periods,

, including tribes,

anges administra

LEASED NOVEMBER

irements for exch

, by contract; and

rmance of Qualifi

rance laws ad fed

f plans,

ion on plans to cur

ized format,

igibility and deter

the actual cost of

ns,

idual responsibilit

d to employers,

es grants to entiti

s,

and

ive costs.

7,2010)

nges which inclu

2) oversight respo

ed Health Plans (Q

eral requirements

rent and prospect

ination of eligibil

coverage taking i

requirement,

es assisting consu

8

e 1) minimum

nsibilities the

HPs). Plans

in the Public Heal

ive enrollees,

ity for individuals i

to account eligibil

ers.

h

n

ity


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tional Conferen

ASKS

HEALTH BENEFITS EX

IN

PROGRESS

CO

s Check List for

e of State Legisl

CHANGES

PLETED IMPLEME

DA

FY2011

Health Reform I

atures

NTATION

TE

Actions GUIDAN

I. OV

mplementation

E FOR STATUTORY RE

RSIGHT RESPONSIBILI

HHS is required t

QHP by an Excha

1. Marketing2. Network ad3. Accreditatio4. Quality impr5. Uniform enrAdditional areas

include:

1. Informationand availabil

2. Consideratiothe plan just

3. Public discloand disenrol

other inform

4. Timely inforspecified pr

5.

Information6. Information

QUIREMENT (BASED

TIES

o develop regulat

nge:

quacy

for performance

ovement and repo

llment procedure

here exchanges

on the availability

ity of essential co

n of plan patterns

ifications for curre

sure of plan data i

lment data, claims

ation identified by

ation for consum

viders,

for participants inon plan quality im

N HHSGUIDANCE R

ry standards in fiv

measures

rting

s

ust ensure plan

of innetwork and

munity providers

and practices with

nt premium incre

entified, includin

denials, rating pra

HHS,

ers requesting the

group health planrovement activiti

LEASED NOVEMBER

e areas that insur

ompliance with re

outofnetwork pr

,

respect to past p

ses,

claims handling p

ctices, cost sharin

ir amount of cost

,es.

7,2010)(CONTINUE

rs must meet in o

gulatory standard

oviders, including

emium increases

olicies, financial d

g for out of netwo

haring for specific

9

D)

rder to be certifie

established by H

provider directori

nd a submission

isclosures, enrollm

rk coverage, and

services from

as

S

s

f

ent


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tional Conferen

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HEALTH BENEFITS EX

IN

PROGRESS

CO

s Check List for

e of State Legisl

CHANGES

PLETED IMPLEME

DA

FY2011

Health Reform I

atures

NTATION

TE

Actions CLARIFIC

Perassu

StatHHS

1. Wh2.

Wh

3. Wh20

4. Wh5. Wh6. Wh

re

Statunl

mplementation

TION AND POLICY G

ormance Measur

re transparency.

e Choices. Federal

may offer recom

ether to form the

ether to form regiether to elect the

6, which would li

ether to require a

ether to establish

ether to extend s

uired in the ACA).

e Authority. The f

ss authority to op

IDANCE (BASED ON

s. Standardized p

rules will clarify t

endations and te

exchange as a gov

onal exchanges oroption under the

it access to exch

dditional benefits

a competitive bid

me or all exchang

ederal governmen

erate the exchang

HSGUIDANCE RELEA

blic data reportin

at the following p

chnical assistance

ernmental agency

establish interstatCA to use 50 em

nge coverage to e

in the exchange b

ing process for pl

especific regulati

will work with th

has been delegat

SED NOVEMBER 17,

g will be used to e

olicy areas, amon

to States as they

or a nonprofit en

e coordination forloyees as the cuto

mployer groups o

yond the essentia

ns,

ns to the outside

e Governor of the

ed to a specific au

010)(CONTINUED)

aluate exchange

others, are State

ake these decisio

tity,

certain functions,ff for small group

50 or less,

l health benefits,

insurance market

State as the chief

thority through st

11

erformance and

decisions, althoug

s:

market plans until

(beyond what is

xecutive officer

te law.

h


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HEALTH BENEFITS EX

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s Check List for

e of State Legisl

CHANGES

PLETED IMPLEME

DA

FY2011

Health Reform I

atures

NTATION

TE

Actions

RulesFEDERAL

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en

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mplementation

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ment period 60

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ady meets standa

eveloped standar

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ere released Nov

ays.

FFP of 90 percen

ms until calendar

FFP of 75 percen

rds and after 2015

s will build upon t

ICAID INFORMATION

MINATIONS AND EN

ember 3, 2010.

for state expendi

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for maintenance

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he work of the M

ECHNOLOGY ARCHIT

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lation or

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itecture (MITA) (s

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tional Conferen

ASKS

HEALTH BENEFITS EX

IN

PROGRESS

CO

s Check List for

e of State Legisl

CHANGES

PLETED IMPLEME

DA

FY2011

Health Reform I

atures

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tional Conferen

ASKS

STE AND ABUSE

IN

PROGRESS

CO

s Check List for

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Health Reform I

atures

MENTATION

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. 1, 2011 ISS

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State Legislato

tional Conferen

ASKS

re Facilities & Wo

IN

PROGRESS

CO

s Check List for

e of State Legisl

rkforce

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FY

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atures

ENTATION

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ayments will be in

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DDITIONAL RESIDEN

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ing entity which h

MENTS TO TEACHING

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addition to GME

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is purpose may no

Y POSITIONS.

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icians.

ral areas with few

ad a voluntary resi

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alth Service Act r

ers (THCs) for the

(GME) training pr

ayments and will

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rcent if the THC fai

t exceed $230 mill

ribute unfilled res

have been unfilled

r than 250 acute

dency reduction p

T OPERATE GRADUA

quiring HHS to m

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ograms.

not count against

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ls to report certai

ion, for the period

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ke payments for

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tional Conferen

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RE FACILITIES &WO

IN

PROGRESS

CO

s Check List for

e of State Legisl

KFORCE

MPLETED IMPL

Dec

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Health Reform I

atures

MENTATION

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. 31, 2011 ISS

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munity Health Ce

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The 201

State Legislato s Check List for Health Reform I

mplementation


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tional Conferen

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RE FACILITIES &WO

IN

PROGRESS

CO

s Check List for

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KFORCE

MPLETED IMPLE

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Sept

Health Reform I

atures

MENTATION

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adline

. 30, 2011

ISSU

1

mplementation

E [GRANTOPPORTUN

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RE TO EXPAND ACCES

illion beginning i

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rovides research

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mic health center

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nd the state has

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ice, construction

h university that

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the schools, the

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Health Reform I

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INATION FOR CERTAI

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STER.

dating process, fo

ven fiscal years

Robert T. Stafford

de was eligible for

effort for optiona

if the state certifi

cation is made or

after December

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State Legislators Check List for Health Reform Implementation