A service of Maryland Health Benefit Exchange

Maryland Health Benefit ExchangeImplementation Advisory Committee

MeetingAugust 7, 2014

A service of Maryland Health Benefit Exchange

Welcome & Approval of Minutes

Michele EberleActing Director, Plan & Partner ManagementMaryland Health Benefit Exchange

A service of Maryland Health Benefit Exchange

Producer Data Discussion

Christopher YeiserManger, Producer OperationsMaryland Health Benefit Exchange

4

Producer Data – Legacy HIX

834 Enrollment File – 2 Data Elements• Broker Name• Broker National Producer Number (NPN)

Broker File – 10-12 Data Elements• Plan was to send monthly• Only got sent once

During 2014

5

Broker Data 2014

NationwidePermanentNot assigned by you or us Not private, no HIPAA concernsEasily cross-referenced with NAIC online tools

Why we used NPN

6

Broker File - 2014

Agency Name if we had it

NPN

Broker Name and Contact Info

Agency Tax ID if we had it

7

Broker Data – 2015

834, Deloitte spec – 3 data elements– Broker Name – Broker License Number (not NPN)– MHBE-assigned account number

Broker File– Scheduling/Frequency… first file Feb. 1?– Data Fields – Same fields as 2014? Add License No.?– Format – XML, CSV, other?– Where do we send?

Planning for Broker Data 2015

8

THANK YOU!

Christopher YeiserManager, Producer Operationschristopher.yeiser@maryland.gov

Comments & Questions

A service of Maryland Health Benefit Exchange

HIX System Updates

Ryan GooldProgram Management OfficeMaryland Health Benefit Exchange

10

Carrier Relations – Existing System

Major activities with carriers winding down• Life Events Testing – CareFirst done through Cycle 3,

Evergreen not participating, UHC Kaiser in Cycle to targeted to complete 8/15/14

• Reconciliation – All to be delivered by tomorrow 8/8/14

EDI Operations Status

11

Carrier Relations – Existing System

Backlog Reduction– Life events that were reported since Jan 1- 45% have been

processed

Developed operational and technical processes – Outreach strategy– Policy for SEP – Outreach underway for aging out dependents

Life Event Operations Status

A service of Maryland Health Benefit Exchange

SHOP Direct Enrollment Process Modifications

Stephanie LeeManger, Producer OperationsMaryland Health Benefit Exchange

13

MHC SHOP Direct Enrollment Policy & Procedure Key Updates

Procedure– Removed all reference to Third Party Administrator (TPA) as it relates to selling

certified Qualified Health & Dental Plans.

– Step 1a. Carriers identifies to the SHOP-authorized producer or employer certified QHP/QDP plans for sale on the SHOP Exchange and off the SHOP Exchange.

– Step 6. The carrier has the employer and its employees complete a carrier- specific enrollment process and provide the employer with an exact premium quote.

– Step 7. Third Party Administrator (TPA) for premium payment collection.

14

MHC SHOP Direct Enrollment Policy & Procedure Key Updates (cont.)

Procedure

– Step 11. Address (City, State and Zip Code) of the employee to be included as part of the monthly “snap shot file” membership file form carriers.

– Step 12. If an employer group is listed on the carrier's membership file and MHBE does not have a completed application on file, MHBE will

request the point of contact from the carrier.

– Step 12. A letter will be mailed to the employer requesting they submit an application and inform them of the inability to receive tax credits without an eligibility determination from MHBE.

15

Comments/Feedback

We welcome any comments/feedback by close of business Monday, August 11, 2014 to the following email address.

MHBE.SHOP@Maryland.gov

A service of Maryland Health Benefit Exchange

SHOP RFP & Renewal PlanUpdate & Next Steps

Michele EberleActing Director, Plan & Partner ManagementMaryland Health Benefit Exchange

17

SHOP RFP

RFP technical & oral presentations completeReview committee final recommendation by FridayPresent to MHBE board August 19th Meet with awardee(s) and commence planningEstablish working groups to address issues– TPA – MHBE interactions– Carrier – TPA interactions– Employer Eligibility determinations– Broker of Record / TPA changes– Appeals process & workflow– Reporting

18

RENEWAL PLAN

Continued work with CMS to approve plan

Close to finalizing

Likely individuals who do not come back into the system to renew will be auto-renewed in an on-Exchange plan without APTC or CSR

Understand need to complete and publish the final renewal plan

A service of Maryland Health Benefit Exchange

HBX System Update

Dennis GloriosoProgram Management OfficeMaryland Health Benefit Exchange

20

System Update

2020

Today

A service of Maryland Health Benefit Exchange

HBX User Acceptance Testing

Dennis GloriosoProgram Management OfficeMaryland Health Benefit Exchange

22

Carrier Testing Agenda

Validate RatesPlan ShoppingEDI TestingTimeline

23

Glossary

SIT – System Integration TestingUAT – User Acceptance TestingEDI – Electronic Data InterchangeRelease 1 – Plan ManagementRelease 2 – Eligibility & Enrollment

24

Validate Rates

Carriers want to ensure rates submitted and approved by MIA are correctly loaded into the systemFour cycles to validate rates

25

Validate Rates – Initial Preview Testing

August 18 – August 22Utilizes the last templates submittedDeloitte will send screenshots to carriers from the SIT environment:

– Templates have been previously loaded– Screenshots from plan shopping– Specific to each carrier

Provide premium rates per plan by rating areaAPTC amounts will be set to zero in order for the plan rates to be consistent across the income levels

26

Validate Rates – Initial Preview Testing (cont.)

  Scenarios

Income 17,000 (CSR Tier 1)

20,000 (CSR Tier 2)

25,000 (CSR Tier 3)

50000 (QHP)

Age 32 32 32 32

County Each of these scenarios will run four times using a county from each rating area.*

Each Plan For each scenario, a screenshot will be taken for every plan that appears when shopping for plan. These plans will be sorted by metal level.

*Harford, Charles, Montgomery, & Frederick counties

27

Validate Rates – Release 1 UAT

August 8 – September 8August 8 – August 22: MHBE PMO will perform UAT on Release 1 with test plan data previously submitted.August 25: MHBE PPM will perform UAT on Release 1 with MIA-certified SERFF plan templates.

– Once the plan data is uploaded, an Excel extract will be downloaded and sent to Carriers for review on August 27.

– Carriers to provide feedback by September 4.

Will provide Excel extract template beforehand.

28

Validate Rates – Release 2 EDI SIT

August 14 – September 19– If the templates submitted to Deloitte are the same plans approved by MIA, EDI

testing can be used to validate rates– Carriers are expected to load these files and validate the data as done in

Production– Scenarios will be shared later in the presentation

29

Validate Rates – Release 2 UAT

September 22 – October 17All defects, enhancements, changes, etc. will follow MHBE’s defect management process.Since Release 1 goes live on 10/1, any changes identified during this phase will require updates to Production.May require resubmission of templates to MIA.4-hour training session will be arranged for carriers in September.

30

Validate Rates – Release 2 UAT (cont.)

September 22 – October 3: unstructured carrier UAT testing– Offsite carrier personnel with access to the system.– Carriers can run multiple anonymous browsing scenarios to validate rates in real

time.– If any defects are identified during the unstructured testing, carriers are required

to submit screenshots of the steps to MHBE by October 6.

October 13 – October 17: structured carrier UAT testing– We will request three representatives from each carrier for onsite testing.– Carrier representatives will be provided with predefined test scenarios/scripts.– October 13 is last day for carriers to submit changes onsite.

31

Plan Shopping

Ensure plans are displayed correctly with respect to regulatory, marketing, consumer requirements, etc.Two cycles to validate plan shoppingView CT Health

– Plan shopping will be almost identical– Use it as a benchmark to see how plans will be displayed– www.accesshealthct.com

Deloitte to send screenshots to carriers from the SIT environmentRelease 2 UAT :: September 22 – October 17

32

EDI Testing

Ensure EDI systems are correctly passing data.Data entered in the application is transmitted as expected to the carriers.Release 2 EDI SIT :: August 14 – September 19

– August 14 :: Initial connectivity testing (ensure files are dropped and picked up successfully)

– August 18 – August 27 :: Initial add & effectuation– August 28 – September 19 :: Change/cancel after effectuation

Release 2 UAT :: September 22 – October 17– Viewed as final validation

33

EDI Testing - Scenarios

Number Test Case Add Change Cancel Head of Household1 Change plans within carrier l l    2 Change planes between different carriers l      3 Non-payment cancellation l      4 Non-payment termination l      5 Dependent Gender Change l l    6 Gap in coverage l l    

7Member changes their effective date during open enrollment.  Requires cancellation record for the original effective date before receiving the new effective date.

l l    

8Newborn add prior to the parent enrollment and then terming the newborn record once the parent was enrolled.  This would require moving the newborn to the parent record.

l l    

9 Dependent Date of Birth Change l      10 Dependent Gender Change l      11 Change coverage level and add son & daughter (from Subscriber to family) -

retroactive l      12 Enrollment for a family of 6 with APTC l      13 Dependent-only coverage scenario with multiple dependents (minimum of 4

dependents) l      

14 Change in income for Subscriber resulting in a loss of coverage. l l    

15 Enroll family where a dependent is the child of domestic partner. l      16 Exchange sends same sex gender for primary and spouse l      17 Retroactively reinstate an incorrectly terminated subscriber l l    18 Retroactively reinstate an incorrectly terminated dependent l l    19 Income change resulting in change in eligibility, new plan selection l l    20 User enrolls in a QHP, but is not currently receiving coverage and chooses to

cancel the enrollment l      

21 User enrolls in a QHP. The user is the primary applicant for a multi-member household. l      

22 User enrolls in a QHP. The user is the primary applicant and the only member in the household. l      

34

EDI Testing - Scenarios

Number Test Case Add Change CancelHead of 

Household

23 User enrolls in a QHP. The user is the primary applicant and the responsible party for the dependent. l      

24 User enrolls in QHP with APTC. l      25 The user enrolls in a 20 year old dependent into a dependent only QHP. l      26 The user enrolls in a 10 year old dependent into a dependent only QHP. l      27 The user enrolls in a 10 year old and 15 year old dependent into a

dependent only QHP. l      

28 The user enrolls in a 10 year old, 15 year old and 20 year old dependent into a dependent only QHP. l      

29 The user enrolls into a QHP with no APTC or CSR l      

30 The user enrolls into a QHP with APTC but no CSR l      

31 The user enrolls into a QHP with APTC and CSR l      32 A family of two enrolls into a QHP without APTC or CSR l      33 A family of two enrolls into a QHP with APTC but without CSR l      34 A family of two enrolls into a QHP with APTC and with CSR l      35 Subscriber and non-Spouse Dependent into a QHP without APTC or CSR l      

36 Subscriber and non-Spouse Dependent into a QHP with APTC but without CSR l      

37 Subscriber and non-Spouse Dependent into a QHP with APTC and with CSR l      

38 A household enrolls into a family plan (AI/AN Plan) l      39 The primary subscriber conducts multiple demographic change requests in

the same day l l l  

40 The primary subscriber reports income change, which cause the individual to lose ATPC, and adds a new dependent l l l  

41 The subscriber changes relationship status l l l  42 The subscriber is a handicapped individual over the age of 26 l l l  

35

EDI Testing - Scenarios

Number Test Case Add Change Cancel Head of Household43 A family of 4, goes through a divorce l l l l44 The primary subscriber dies l l l l45 Individual ages out at of QHP at 65 l   l  46 Dependent ages out at 26 years of age l   l  47 Subscriber reports change in address l l l  48 Subscriber reports change in name and marital status l l l  

49 Non custodial parents applies for coverage of dependent l l l  

50 User applies as primary subscriber with a domestic partner or same sex marriage l l l  

51 Subscriber enters the same SSN for multiple household members l l l  52 Alter or add SSN for dependent l l l  53 Subscriber moves out of state l l l  54 Subscriber is receiving ABD benefits and desires to purchase a full priced QHP l l l  55 Primary subscriber divorces spouse l l l l

56 Subscriber is granted a special enrollment due to marriage l   l  

57 User has used an agent/broker to register, create an account, complete an application, run through eligibility determination, qualify for and select a QHP. l l    

58 User enrolls in a QHP, and chooses to terminate coverage after the original coverage start date. l   l  

59Initial enrollment of Household with 3 dependents: 1 in home address, 1 in different county (rating area), 1 in different state (college)

l      

60 Subscriber indicates Spanish as their language l      

36

EDI Testing - Scenarios

Number Test Case Add Change Cancel Head of Household

61Race/Ethnicity in Household: Subscriber=Native American, Spouse=Asian, Child=Mexican

l      

62Multiple changes with differing effectuations on differing dates: Added Dependent (baby)- previous month.Address change to new rating area - tomorrowDropping dependent (22year old moving out) - 2 months into future

l l l  

63 Subscriber terminates plan after effectuation l   l  64 Subscriber cancels plan before effectuation l   l  65 Primary subscriber or other household member completes a name change l l    

37

Testing Timeline – August 2014

MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY1

4 5 6 7 8

11 12 13 14 15 SIT - Connectivity 

Validation

18 19 20 21 22SIT – “Initial Add and Effectuation” - (begin)

 

SIT - Plan Shopping Screenshot  using Citizen Portal - (begin)

SIT - Plan Shopping Screenshot  using Citizen 

Portal - (end)

25 26 27 28 29

SIT – “Initial Add and Effectuation” - (end)

 SIT –”Change/ Cancel after Effectuation” – 

(begin)

 

38

Testing Timeline – September 2014

MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY1 2 3 4 5

Holiday

8 9 10 11 12 

15 16 17 18 19SIT –”Change/ Cancel after Effectuation” –

(end)

22 23 24 25 26UAT – Unstructured

Carrier Testing begins

29 30       

39

Testing Timeline – October 2014

MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY1 2 3

      UAT – Unstructured Carrier Testing ends

6 7 8 9 10UAT – Last day to

submit defects offsite 

13 14 15 16 17UAT – Carrier

resources onsiteUAT – Carrier

resources onsiteUAT – Carrier

resources onsiteUAT – Carrier

resources onsiteUAT – Carrier resources

onsite *last day to submit

defects onsite

20 21 22 23 24     

27 28 29 30 31

40

NEXT MEETING: August 21, 20142:00 – 4:00PM

UMBC Tech Center

PUBLIC COMMENTS?