Certification, Quality, & Plan Display. April 7 th, 2014

Transcription

1 Certification, Quality, & Plan Display April 7 th, 2014

2 Agenda Welcome and Introductions 12:00 12:05 QHP / QDP Certification Overview 12:05 12:15 Plan Shopping and Detail Pages 12:15 12:30 Quality and Company Overview Pages 12:30 12:45 CMS: Quality Rating System 12:45 12:50 Next Steps / Additional Discussion 12:50 1:00 2

3 OUR OBJECTIVE Gain feedback on proposed quality and plan display enhancements to enable a smooth filing / certification process. 3

4 Agenda Welcome and Introductions 12:00 12:05 QHP / QDP Certification Overview 12:05 12:15 Plan Shopping and Detail Pages 12:15 12:30 Quality and Company Overview Pages 12:30 12:45 CMS: Quality Rating System 12:45 12:50 Next Steps / Additional Discussion 12:50 1:00 4

5 QHP Certification: Level Setting SB requires that QHP / QDP certification responsibility is coordinated between the Division of Insurance (DOI) and Connect for Health Colorado to avoid any duplication of effort QHP Certification is not final until both the DOI and the Connect for Health Colorado have completed their approvals The DOI and Connect for Health Colorado work via the existing filing system called SERFF and federally mandated plan templates to review, approve, certify, and display plans 5

6 6 Critical Partnerships: Our Carriers

7 Individual Marketplace 150 Health Plans 22 Dental Plans 7

8 Small Group (SHOP) Marketplace 92 Health Plans 45 Dental Plans 8

9 2014 QHP / QDP Certification Timeline APR MAY JUN JUL AUG SEP OCT QHP Certification Rate Filing Rates Filing Binder Part 1 (5/18) C4HCO Templates Quality & Company Overview (5/31) Other Filings All Other Filings Binder Part 2 (6/30) Final QHP Certification Notice (7/31) QDP Certification C4HCO Template Rate Filing Rates Filing Binder Part 1 (6/14) Other Filings All Other Filings Binder Part 2 (6/30) Company Overview (5/31) Final QDP Certification Notice (7/31) Legal Agreements TPA Executed (5/10) Carrier Participation Agreement (CPA) Released (7/8) Provide Feedback for CPA CPA Negotiations Complete (8/15) CPA Executed (9/15) A goal for 2015 QHP / QDP certification is to allow for additional time for review / testing prior to open enrollment and a more streamlined process. 9 Due to DOI Due to C4HCO

10 2015 QHP Certification Highlights Carriers are required to complete fillings by 5/15/2014 The federal templates are going to be due to SERFF / the DOI in late June o Final Date is dependent on CMS releasing the revised 2015 templates that in Connect for Health Colorado and the DOI are providing integrated instructions for carriers Changes on the shopping portal / user interface drive instructions / requirements for template completion. We need your input ASAP on proposed changes so they can be prioritized and we can integrate them into the 2015 QHP process. 10

11 Agenda Welcome and Introductions 12:00 12:05 QHP / QDP Certification Overview 12:05 12:15 Plan Shopping and Detail Pages 12:15 12:30 Quality and Company Overview Pages 12:30 12:45 CMS: Quality Rating System 12:45 12:50 Next Steps / Additional Discussion 12:50 1:00 11

12 Setting Expectations We want your feedback and ideas they help us serve the customer This discussion is about proposed changes we cannot promise functionality or timing of the updates Connect for Health Colorado has gathered some proposed changes that we will use as a starting point for today s discussion based on feedback from HCGs, brokers, and other staff Let s get started! 12

13 Shopping Page: Proposed Changes 1. New Filters o Plan Type (HMO, PPO, EPO) o HSA Eligible (Yes / No) 2. Add Office Visit Information o Copay / Consurance to see PCP / Specialist Add Customer Satisfaction Label above the Quality Stars AND add See Details link to Quality Page 4. Enable logo to go to the Company Overview Page 5. List provider network name with link to details on the network 6. Add View More Plans Buttons at the bottom of the page 7. Add additional clarity to Pediatric Only Dental Plans (NO coverage for adults) 13

14 Plan Detail Page: Proposed Changes 1. Remove In Network (Tier 2) column 2. Reorder sections / categories and benefits Update / Re-Skin the Plan Document Names 4. Modify No Charge language o On HMO and EPO products to reflect Not Applicable for In Network and No Benefit for Out of Network 1 o Dependent on SERFF Template s and technology level of effort Add whether or not a referral is required to see a specialist (Y / N) 6. Dental Plans Should Show all Benefits for Adults and Children Separately including relevant hover text 7. Clean-up Formatting (e.g., $ etc.) Add Customer Satisfaction Label above the Quality Stars AND add See Details link to Quality Page 14

15 Plan Detail Page Additional Documentation Desired sorting of plan benefits and categories QHP: Addition of a few new benefits for display o Non-Preferred Generic Drugs o Well Baby Visits o Dialysis o More specific habilitative and rehabilitative benefits o More granular pediatric dental benefits o Addition of Chiropractic Spinal Manipulations QDP: Duplicating all benefits for adults and children o Changing language on deductibles and OOP Max to reflect dental o Clarifying Child vs. Adult deductible and OOP Max *Please reference the detailed benefit tables provided 15

16 Standard Dental Benefits Summary QHPs are all required to provide the federally designed Summary of Benefits and Coverage (SBC) Dental doesn t have an equivalent, making plan comparisons more challenging for the consumer Connect for Health Colorado would like create a standard standalone dental product benefit template Feedback? Questions? Volunteer to help? 16

17 Agenda Welcome and Introductions 12:00 12:05 QHP / QDP Certification Overview 12:05 12:15 Plan Shopping and Detail Pages 12:15 12:30 Quality and Company Overview Pages 12:30 12:45 CMS: Quality Rating System 12:45 12:50 Next Steps / Additional Discussion 12:50 1:00 17

18 Quality and Company Overview Pages Quality Summary Page Company Overview These resources need to be more accessible to customers, brokers, and HCGs 18

19 Proposed Updates to Quality Display Get to Status Quo Include Label of Stars on Shopping Page Add link to Quality Details below star on Shopping Page Wish List / Nice to Have Convert from PDF to Web Page (still printer friendly) Include Hover Text on Quality Pages instead of the Definitions section at the end Content on Quality Pages Include Exchange Accreditation Status AND Commercial Health Plan Accreditation Status The Marketplace will allow carriers to update narrative and we will refresh the CAHPs and other metrics appropriately

20 Proposed Updates to Company Overview Get to Status Quo Enable the carrier logo to open the Company Overview Wish List / Nice to Have Convert from PDF to Web Page (still printer friendly) Content on Company Overview Require more detail about networks offered (e.g., hospitals, average number of general physicians by area, other statistics) The Marketplace will allow carriers to update narrative and we will update the MLR etc

21 Agenda Welcome and Introductions 12:00 12:05 QHP / QDP Certification Overview 12:05 12:15 Plan Shopping and Detail Pages 12:15 12:30 Quality and Company Overview Pages 12:30 12:45 CMS: Quality Rating System 12:45 12:50 Next Steps / Additional Discussion 12:50 1:00 21

22 CMS Quality Rating CMS Released a Proposed Quality Rating System on 3/28 Comments are Due to CMS by 4/28 The Marketplace will facilitate a Board Policy and Regulations Committee on 4/21 Please submit your feedback to us and attend the meeting 22

23 Agenda Welcome and Introductions 12:00 12:05 QHP / QDP Certification Overview 12:05 12:15 Plan Shopping and Detail Pages 12:15 12:30 Quality and Company Overview Pages 12:30 12:45 CMS: Quality Rating System 12:45 12:50 Next Steps / Additional Discussion 12:50 1:00 23

24 Next Steps Action Item Submit any additional comments and feedback on shopping / plan / quality display to carriers@connectforhealthco.com Timing 4/11/2014 Submit any comments on the CMS Quality Rating System Scoring Specifications to carriers@connectforhealthco.com Participate in the Policy and Regulation Committee to provide additional input on the comments for the Quality Rating System 4/15/2014 4/21/ :30 2 pm 24

25 25 QUESTIONS?