No Rest for the West in Building Exchanges

Grab your bags, we’re road tripping out west to visit some newly established exchanges!  Washington, Oregon, Colorado and Nevada have all established exchanges and appointed governing boards. These states are moving forward, making policy decisions on navigator programs and on market and plan rules. They are also focused on the nuts and bolts of establishing their new exchange businesses, including operations, planning, and procurement processes.
Navigators
Exchanges are required to establish a navigator program to assist consumers in selecting insurance coverage. Washington released a draft policy brief on navigators, a document based on feedback from a recent statewide survey of Washington residents and interviews with stakeholders. Interviewees included community organizations, health care associations, brokers, insurance carriers and consumer advocacy organizations. According to the survey, an almost equal proportion of individuals will want help online, by phone, and in person. The brief recommends that navigators be knowledgeable about the exchange and Medicaid, trustworthy and impartial, easily accessible, and that they include diverse groups.
Plan Certification and Market Rules
Exchanges are charged with certifying plans as Qualified Health Plans (QHPs) that meet minimum requirements, but also have the option to impose additional requirements. Washington’s HB 2319 proposes to address the QHP certification requirements by:

• Establishing certification criteria.
• Creating the option for the exchange board to request the insurance commissioner adopt additional standards for plans to be certified as QHPs.

Washington’s proposed legislation also sets down market rules for plans sold both inside and outside the exchange, including:

• Carriers that want to offer individual plans outside the exchange must offer silver and gold individual plans in the exchange.
• Carriers that want to offer small group plans outside the exchange must offer silver and gold small group plans in the exchange.
• Carriers that want to offer catastrophic or bronze level plans outside the exchange must offer those same plans through the exchange.

Colorado’s exchange board is discussing options related to the Small Business Health Options Program (SHOP) exchange and defining the state’s small group market. A set of recommendations by staff call for one administrative structure for both exchanges in order to maximize efficiencies, but recommends against merging the individual and small group markets at this time and revisiting the decision later. At a recent meeting, the board approved these recommendations, and decided to initiate a study on keeping the markets separate. The staff recommendations also advise keeping the current definition of small employer until 2016 to minimize market disruption.
Business Plan and Operations
The Oregon Health Insurance Exchange Corporation released its first business plan in February. The plan includes an operations timeline and addresses issues such as customer service and plan requirements. As part of an ongoing plan to ensure the exchange is self-sustaining beginning in 2015, the document lays out startup costs, staffing levels, and financial and enrollment projections. Some of these estimates and projections may be helpful for other states developing exchanges.
HB 4164, introduced in the Oregon legislature, would provide legislative approval of the Exchange’s business plan and fixes a drafting error from the state’s exchange enabling legislation, thereby allowing the exchange to establish lines of credit and financial accounts.
RFPs and Policy Decisions Timelines
In addition to selecting an Executive Director, Nevada’s Silver State Exchange Board approved an RFP release calendar as well as a timetable for advisory committees to submit recommendations to the board on policy decisions. The upcoming policy recommendations will cover finance and sustainability, plan certification and management, SHOP exchange, reinsurance and risk adjustment, and consumer assistance. The first RFP will address business operations and will be released in May. Other RFPs will be released later this year, including proposals for navigator services and marketing, outreach, and advertising.
What exchange policy decisions is your state tackling? Tell us in the comments below!