Exchange Decision Points Requiring Further Discussion

DRAFT August 18, 2011 Exchange Decision Points Requiring Further Discussion

Advisory Committee Meeting August 23, 2011

Decision Decision Point Advisory Committee Final Resolution Point No. Discussion 1. Exchange Structure:  Should be a Whether to structure the governmental agency; Exchange as a governmental unresolved whether it agency or a non-profit entity. should be a new, existing, ACA § 1311(d)(1). or independent executive agency 4. Separate Risk Pools for  Gorman to present its Individual and Small Group findings on merging the Markets: individual and small Whether to merge risk pools for group markets as rating the individual and small described in its group markets. ACA § 1312(c) 5/31/2011 report and an explanation of how the results of its findings are likely to change as a result of PL 90 and ACA 6. Small Employers:  Gorman to present its Whether to use the ACA findings on changing the definition of small employer (1- definition of small 100 employees) or elect the employer to 100 option to use 50 employees as the employees cut-off for small group market plans until 2016. ACA §§ 1312(f)(2)(A); 1304(b)(2)-(3) 7. Counting Employer Size:  Optumas to provide What legal standard to use for modeling on effect of counting employer size. ACA counting part-time and § 1304(b); HHS Bulletin 99-03 seasonal employees on the number of employers who will be eligible to participate in the Exchange starting 2014  Should this be included in state legislation, or delegated to Exchange

DC: 4079096-3 Decision Decision Point Advisory Committee Final Resolution Point No. Discussion 11. Exchange Governance —  Consider a 7 to 9 Board Appointment and member board appointed Reappointment Process: by Governor and subject The process for appointing to confirmation by members of the board or other Legislature entity that will govern the Exchange. ACA § 1311 12. Exchange Governance —  Review conflict of Board Member Composition: interest provisions in  Board may not be made up proposed rules. of a majority of voting representatives with a  Consider a Board conflict of interest, including comprised of the representatives of health following insurance issuers, agents, representatives: brokers, or any other  small employer individual licensed to sell  large employer health insurance. See 45  insurer C.F.R. § 155.110(c)(3) (prop.)  broker  provider  tribe  consumer  2 at large

13. Exchange Governance —  Discuss whether to Board Member Qualifications: specify qualification A majority of the voting members requirements in must have relevant experience in enacting legislation health benefits administration, health care finance, health plan purchasing, health care delivery system administration, public health, or health policy issues related to the small group and individual markets and the uninsured. 45 C.F.R. § 155.110(c)(4) (prop.)

- 2 - Decision Decision Point Advisory Committee Final Resolution Point No. Discussion 15. Exchange Governance —  Discuss whether Advisors: legislation should specify ACA provides that Board must how to take into account regularly consult with certain stakeholder interests, or stakeholders. ACA § 1311(d)(6). whether this should be In addition to the statutorily listed delegated to Exchange stakeholders (educated health care consumers who are enrollees, enrollment facilitators, advocates for hard-to-reach populations, small businesses and self-employed individuals, and State Medicaid and CHIP agencies), HHS would add the following:  federally-recognized tribes,  public health experts,  health care providers,  large employers,  health insurance issuers, &  agents and brokers 45 C.F.R. § 155.130 (prop.). (Note: the Board need not necessarily appoint advisory committees to meet this requirement, but it is one avenue for compliance.)

17. Exchange Operating Model :  Review ACA What operating model to choose requirements for (e.g., “active purchaser” model, certifying health plans “open marketplace” model, etc.)  Discuss whether this for certifying plans to participate should be in legislation, on Exchange or delegated to Exchange

- 3 - Decision Decision Point Advisory Committee Final Resolution Point No. Discussion 22. Navigators:  Discuss duties of Whether to impose any additional Navigators and whether requirements on Navigators in the Navigators should or Exchange beyond the minimum need to be subject to a in ACA § 1311(i) limited licensing or registration process  Discuss whether licensing/registration process should be in the form of training  Discuss whether decision can or should be delegated to Exchange

23. Participation by Brokers and Agents: Whether to allow agents and brokers to assist individuals enrolling in plans through the Exchange. ACA § 1312(e).

25. Finances/Revenues:  Discuss further how other Whether to give the Exchange States are planning to authority to charge collect revenue for assessments or user fees to Exchange health carriers or otherwise  Discuss how many generate funding necessary to participants are likely to support its operations, to purchase through an ensure that the Exchange is Exchange self-sustaining by 2015. ACA § 1311(d)(5)(A).  Consider imposing a cap on the amount the Exchange may collect