ACA2014 & Beyond

Rhonda FossittSenior Deputy Director

ACA: 2014 Michigan Successes

• 272,539 Michiganders enrolled in Marketplace plans

• 13 Health Companies Participated in Marketplaces

• Federal/State partnership protects Michigan companies and consumers

ACA: Key Decisions

• Transitional Policy: Nov. 2013• Extended Transitional Policy: April 2014• SHOP (Small Business Health Options

Program) Employee Choice: June 2014

ACA: 2015 Challenges

• Short timeline to prepare & approve QHP filings

• Pricing• Late guidance• Redetermination and renewals

2015 Perspective: A Game of Survivor

5

Late Release ofReview Tools

Transitional Policy

Decisions

Employee Choice in SHOP Decision

Turn-over of HHS Staff

Template Challenges

Redeterminationand

Renewals

Interpreting LateHHS Rules

High WorkloadDue to

Participation

Updates for 2015• 18 Health Insurers file for participation on the

Marketplaceo Increase from 13 Health Insurers in 2014o Competition fostered by effective & efficient regulatory

environment• “2015 Marketplace Plan & Rate Information” added

to DIFS website to provide:o Rate Change Requests & Public Commentso Dental Informationo Map of Rating Areaso SERFF Portal: Health Rates & Forms Filings

Deadlines for 2015QHP

Application Submission and Review ProcessMichigan Filing Deadline 06/09/2014Plan ID Crosswalk Template 08/04/2014DIFS Transfers Plan Data to CMS 08/08/2014CMS Reviews Plan Data 08/11/2014

to 08/25/2014

CMS Notifies DIFS of Necessary Corrections to QHP Data

08/26/2014

Final Deadline for Issuers to Resubmit Data Into SERFF

09/04/2014

DIFS Transfers Revisions to CMS 09/05/2014to 09/10/2014

CMS Completes Re-Review of Plan Data and State Recommendations

09/22/2014

Limited Window for Plan Correction 09/24/2014to 10/06/2014

QHP Certification Notices and QHP 10/14/2014Agreement/Final Agreements Sent to Issuers,

Certification Agreements Signed, QHP Data Finalized To11/03/2014

Open Enrollment 11/15/2014

Plan & Benefit Template – Report from DIFS

• In Year 2- actuarial value stayed fairly constant- catastrophic plans understood- out-of-pocket max understood

• Positive Feedback- 25% of companies used data integrity tools & review tools- most companies timely provided complete answers in objection

responses- Ways to reduce errors & objections

- use data integrity & review tools- check Plan & Benefit Template to be sure it matches forms

Preview of the Issues: 2016 and Beyond

• 1/1/2016: Definition of Small Group will increase from 50 to 100 members

• 1/1/2016: Essential Health Benefits will be redefined - criteria unknown

• 1/1/2017: State decision on whether we would add large group to the SHOP

Resources that DIFS Providesto Health Insurers

• Bulletins• Industry Q & A Sessions

- Monthly MAHP Meetings- These questions are added to FAQs on DIFS’ website

• FAQs on DIFS’ website- Affordable Care Act - 11 Categories

• SERFF - State Messages• Conference Calls

What Does HAPPY mean to DIFS Health Plans Staff?

• A successful transmittal of a Binder through SERFF to HHS

• The message that comes back indicates “HAPI”

• We have gone with this theme