Passport Health Plan Welcomes the Opportunity to Continue Serving Medicaid Members in Region 3.

 

 

Commonwealth of Kentucky

Cabinet for Health and Family Services

FOR IMMEDIATE RELEASE Contact: Jill Midkiff

502-564-7042

502-330-1185

 

Medicaid Managed Care Contracts Awarded for Jefferson and Surrounding Counties

Coventry Cares, Humana, Passport and Wellcare will provide coverage beginning in 2013

 FRANKFORT, Ky. (Oct. 4, 2012) – The Commonwealth of Kentucky has signed contracts with four managed care partners to provide health care services to approximately 175,000 Medicaid recipients in Louisville and 15 surrounding counties. These managed care organizations (MCOs) will provide services in Region 3, which is comprised of Breckinridge, Bullitt, Carroll, Grayson, Hardin, Henry, Jefferson, Larue, Marion, Meade, Nelson, Oldham, Shelby, Spencer, Trimble and Washington counties.

The four MCOs awarded contracts for Region 3 are Coventry Cares, Humana, Passport and Wellcare of Kentucky. The contracts are for an initial 18 months with four, one-year renewal options. The new contracts will take effect Jan. 1, 2013.

Earlier this year, the Centers for Medicaid and Medicare Services (CMS) advised the Cabinet that Region 3 could no longer operate with a single managed care provider. Beginning Jan. 1, 2013, CMS requires that Medicaid recipients in Region 3 have a choice of more than one provider for health care services.

“The managed care approach is familiar to Medicaid recipients in the Jefferson County area, but having a choice of managed care organizations is new,” said Cabinet for Health and Family Services Secretary Audrey Tayse Haynes. “Passport has been a good partner and has served the region’s recipients well for 15 years, but the federal government now requires that individuals have a choice of providers. The Cabinet is pleased with the level of interest from the managed care community and we look forward to their work on behalf of our Department for Medicaid Services and the individuals who rely on Medicaid for their health care coverage.”

The Cabinet for Health and Family Service’s Department for Medicaid Services has contracted with Passport to be the sole provider of Medicaid-covered services in Region 3 since 1997. Medicaid recipients in the remaining 104 counties in the Commonwealth have a choice of three MCOs that have been providing managed care services since Nov. 1, 2011.

Over the last four fiscal years, the Medicaid cost for Passport members was reduced 6.5 percent even though health care costs in the southern region of the United States have increased an average of nearly 3.5 percent. The new contracts maintain those savings for the biennium, and protect the Medicaid program against rising health care costs over the next 18 months.

The new contracts will include behavioral health services, as is the case in Medicaid managed care contracts for the rest of the state.

Medicaid recipients and providers in Region 3 will soon receive a letter about these changes. 

The Department for Medicaid Services will enroll Medicaid recipients in Region 3 with the MCO that is determined by a high-tech matching system to be the best fit based upon available provider networks and any special health care needs the individuals may have. Members will receive notice by early November of the MCO with which they have been matched. Upon notice of this match, Medicaid recipients will have 30 days to select a different MCO before the Jan. 1, 2013 effective date of coverage. The Department for Medicaid services will provide information about how Medicaid recipients can choose the best MCO for their needs. Medicaid recipients who wish to switch to a different MCO after Jan. 1, 2013, will have another 90 days in which to request a change.

As required by state procurement law, the Cabinet solicited proposals from managed care companies interested in offering services in Region 3 beginning Jan. 1, 2013. The RFP was issued on June 19, 2012 and contracts with vendors were finalized today.

 

-30-

The Cabinet for Health and Family Services is home to most of the state’s human services and health care programs, including Medicaid, the Department for Community Based Services and the Department for Public Health. CHFS is one of the largest agencies in state government, with nearly 8,000 full and part-time employees throughout the Commonwealth focused on improving the lives and health of Kentuckians.

 

Link:  http://www.passporthealthplan.com/pdf/news/commonwealth-of-kentucky.pdf

 

Consumer Advocates Worry New Medicaid Operators in Louisville Region Will Cause Problems

By Kenny Colston, WFPL

The Louisville Medicaid region will now be home to four different managed care operators. State officials announced the change today.

Joining Passport Health Plan is Humana, CoventryCares and WellCare.

WellCare and Coventry already have statewide contracts for Medicaid and Passport has operated in Louisville for years.

Passport officials say they will still try to continue maintain their high level of care, despite no longer holding an exclusive contract for the region. 

But the new dynamic has consumer advocates like Kentucky Voices for Health’s Jodi Mitchell saying patients are likely to see their quality of care decline.

“That’s really where it comes down to not consumer choice, but who the provider contracts with, because we have seen across the state where there are hospitals who chose to not do business with some of the managed care companies,” she says.

She points to Coventry as one example. The company has broken contracts with many hospitals statewide. And that could affect its provider contracts in Louisville as well.

The new organizations will officially start insuring Medicaid patients on Jan. 1

Link:  http://wfpl.org/post/consumer-advocates-worry-new-medicaid-operators-louisville-region-will-cause-problems

Humana, Passport Join Two Others as New Louisville Medicaid Operators

By Kenny Colston, WFPL

After decades of having one company oversee Medicaid, the Louisville area will now have four private Medicaid providers.

The Louisville area was the first part of the state to have Medicaid privatized, and Passport Health Plan has administered the program ever since.

But the rest of the state has since been privatized, and multiple operators compete for patients across the commonwealth.

The Cabinet for Health and Family Services announced today that Passport will now have competition from CoventryCares, WellCare and Humana.

Medicaid patients will be automatically assigned by the Cabinet to their new insurance provider, with letters informing people of their provider being sent out by November 1st.

The new MCOs will start managing on January 1st.

 

Link:  http://wfpl.org/post/humana-passport-join-two-others-new-louisville-medicaid-operators

 

Editorial | State must avoid Medicaid chaos

By Courier Journal, Published: 12:17 AM, Oct 9, 2012

You could argue, “If it ain’t broke, don’t fix it.”

But “If it ain’t broke, don’t break it” seems more to the point in the Louisville region where Passport Health Plan suddenly is facing competition from three, for-profit companies when it comes to serving about 175,000 Medicaid beneficiaries in Jefferson and 15 surrounding counties.

The state’s hasty launch of managed care statewide last year outside the Passport region clearly was disastrous and chaotic — reports of delays and denial of care still ripple through the system.

Nonetheless, the Cabinet for Health and Family Services has introduced competition in the Louisville area to Passport by announcing it has signed contracts with three companies that will vie with Passport for business.

Passport, a non-profit consortium of doctors, hospitals, pharmacies, dentists and other health care providers, has operated for 15 years as an efficient managed-care service, establishing a solid track record providing high-quality care at low costs. Some unfortunate excesses by previous executives, mostly in travel and entertainment costs, have been corrected and should not detract from its record as a health care agency.

Cabinet Secretary Audrey Tayse Haynes said the change is to satisfy the federal government, which provides about 70 percent of Kentucky’s Medicaid money and wants more competition and choice.

It is essential that Secretary Haynes’ cabinet give its full attention to this transition to ensure people served through Passport do not encounter the disruption that roiled the rest of the state last November. That’s when Kentucky rushed into managed care contracts with three outside companies for some 500,000 Medicaid beneficiaries statewide, prompting an outcry over repeated claims of delays and denials of care.

Payments to health care providers screeched to a halt — forcing some small offices to borrow money just to meet payroll. And providers including doctors, dentists and pharmacists barraged lawmakers with individual stories of patients refused urgently needed procedures and medications.

One crucial area to be affected in the Passport region is mental health services, which currently are provided to Medicaid patients through community mental health centers based in Louisville and Elizabethtown.

Seven Counties Services serves Jefferson and six surrounding counties and Communicare, based in Elizabethtown, serves additional patients in the Passport region. They now are being forced into the same managed-care model that applies to the rest of the state’s mental health agencies.

Mental health advocates from around Kentucky were particularly outraged by last year’s changes they said caused major disruptions for people with mental illness, who depend on medications and regular care to remain stable.

Seven Counties President Tony Zipple said he’s concerned about the potential impact on that agency’s about 30,000 patients, most of whom rely on Medicaid for care. He hopes the state has learned from last year’s rocky transition, noting that there are “some real risks and challenges” for patients with mental illness.

Other advocates have responded with alarm to changes in the Passport region, including Kentucky Youth Advocates which noted the “mass confusion” of last year’s changes and disruption of health care for kids.

Jodi Mitchell, executive director of Kentucky Voices for Health, said the changes in the Passport region threaten “disruption for a lot of members who have been served many years by Passport.”

The cabinet needs to provide close oversight and swift action to ensure the smoothest transition possible. And Passport members need to remember since this is all about choice, they may choose to stay with Passport.

One crucial area to be affected in the Passport region is mental health services, which currently are provided to Medicaid patients through community mental health centers based in Louisville and Elizabethtown.

Seven Counties Services serves Jefferson and six surrounding counties and Communicare, based in Elizabethtown, serves additional patients in the Passport region. They now are being forced into the same managed-care model that applies to the rest of the state’s mental health agencies.

Mental health advocates from around Kentucky were particularly outraged by last year’s changes they said caused major disruptions for people with mental illness, who depend on medications and regular care to remain stable.

Seven Counties President Tony Zipple said he’s concerned about the potential impact on that agency’s about 30,000 patients, most of whom rely on Medicaid for care. He hopes the state has learned from last year’s rocky transition, noting that there are “some real risks and challenges” for patients with mental illness.

Other advocates have responded with alarm to changes in the Passport region, including Kentucky Youth Advocates which noted the “mass confusion” of last year’s changes and disruption of health care for kids.

Jodi Mitchell, executive director of Kentucky Voices for Health, said the changes in the Passport region threaten “disruption for a lot of members who have been served many years by Passport.”

The cabinet needs to provide close oversight and swift action to ensure the smoothest transition possible. And Passport members need to remember since this is all about choice, they may choose to stay with Passport.

 

Link:  http://www.courier-journal.com/apps/pbcs.dll/article?AID=2012310090014

Passport Medicaid region to be split among 4 companies

US says Jefferson County region must offer Medicaid patients choices

By Courier Journal, Tom Loftus, Published: 2:58 AM, Oct 5, 2012  

FRANKFORT, KY. — Beginning Jan. 1, four companies will start managing the health care of roughly 175,000 Medicaid patients in the Jefferson County region — a major change that some say raises concerns about disrupting care.

For the past 15 years, the nonprofit Passport Health Plan has served all Medicaid recipients in the 16-county region.

But on Thursday, the state Cabinet for Health and Family Services said it had signed 18-month contracts with Passport and three other companies — Humana, Wellcare of Kentucky and Coventry Cares — to manage Medicaid recipients’ care starting next year.

Other details of the contracts, including payment provisions, were not released.

Cabinet Secretary Audrey Tayse Haynes said the federal government told Kentucky it could no longer operate with a single managed-care company in the Jefferson County region and must give patients a choice among several providers.

In addition to Jefferson, the region’s other counties are Breckinridge, Bullitt, Carroll, Grayson, Hardin, Henry, LaRue, Marion, Meade, Nelson, Oldham, Shelby, Spencer, Trimble and Washington.

“Passport has been a good partner,” Haynes said. “… But the federal government now requires that individuals have a choice of providers.”

Passport, an organization of major health care providers in the region, was disappointed in the cabinet’s action, and its chief executive, Mark Carter, released a statement expressing concern that the continuity of patient care could be interrupted.

“We will be working with providers and community advocates to minimize disruption in the care of our members,” he said.

Passport had hoped that, if the state went with multiple companies, it initially would assign all recipients to it and then give them an option of moving to another company. Instead, the cabinet initially will assign recipients to one of the four companies.

The cabinet said the state will use “a high-tech matching system” that assigns a person based on “available provider networks and any special health care needs.”

Medicaid recipients will be notified which company they have been assigned to by early November, the cabinet said. They will then have 30 days to change if they wish.

Carter acknowledged that, because Passport’s current business will be shared with three other companies, cutbacks and layoffs are possible.

But he said Passport will begin an advertising campaign soon that will ask recipients to stay with the company. “And if we retain a significant percentage of the population, it may not be necessary to have layoffs.”

A federal decision

Medicaid is the federal- and state-funded health insurance program for the poor and disabled. The federal government pays about three-fourths of the cost, while the state pays the rest.

Passport is the product of an attempt during the early 1990s to save money in Medicaid through managed care. But attempts to form similar organizations in other parts of the state failed.

Last year, under great pressure to curb soaring Medicaid costs, the Beshear administration expanded managed care statewide. Direct management of the program by the state Department of Medicaid Services was handed over to three managed-care companies in Kentucky’s remaining 104 counties.

The transition to managed care in the rest of the state has been bumpy — primarily because of disputes between managed care companies and hospitals within their network of providers.

One dispute raises questions about the network of hospitals and providers that one of the new managed care companies in the Jefferson County region — Coventry Cares — may be able to assemble.

Coventry is already serving the other 104 counties, and KentuckyOne Health said in August that it would terminate its contracts with Coventry.

KentuckyOne Health is the company that resulted from the merger of Jewish Hospital & St. Mary’s HealthCare with St. Joseph Health System early this year.

KentuckyOne said it terminated its contracts with Coventry because Coventry first terminated “without cause” the contracts it had with Our Lady of Peace, a psychiatric hospital that’s part of KentuckyOne, and Taylor Regional Hospital in Campbellsville, which KentuckyOne manages.

Barbara Makovic, spokeswoman for KentuckyOne, said Thursday there’s been no change in the status of KentuckyOne’s decision to terminate its contracts with Coventry. She said she did not immediately know whether KentuckyOne would be part of Coventry’s network of providers in the Jefferson County region.

Coventry released a statement saying it is talking with Kentucky One “and we would be pleased to have them in our network if we can reach an agreement on a new contract.”

Disruption concerns

Passport Board Chairman Bill Wagner, who is executive director of Family Health Centers in Louisville, said he is concerned that “the chaos that has engulfed the rest of the state over the past year” will come to the Jefferson region.

“Confusion over plan enrollment, increased denials, payment delays and new layers of bureaucracy will definitely have an effect on access to patient care,” Wagner said.

Various health care advocates also expressed concerns about the move to multiple managed care companies.

“The transition is likely to cause disruption for a lot of members who have been served for many years by Passport,” said Jodi Mitchell, executive director of Kentucky Voices for health. “Problems have been documented elsewhere in the state about timely payment of claims to providers, pre-authorization of services causing hurdles to treatment, adequate provider networks and drug treatments might change depending on what plan you’re on.”

Andrea Bennett, deputy director of Kentucky Youth Advocates, said the past year’s experience with managed care out in the state has produced “story after story of parents having difficulty navigating the system. We’ve heard providers threaten to give up on Medicaid altogether because they are frightened and still not receiving proper payment.”

Bennett said that, when the state went to managed care last fall, “sometimes siblings were assigned to separate plans and parents didn’t understand how to switch their child to another plan.”

She strongly encouraged the cabinet to clearly communicate the options to Medicaid recipients in the Jefferson region “in a format that is easy for them to understand.”

Link:  http://www.courier-journal.com/apps/pbcs.dll/article?AID=/201210041554/PRIME07/310040073&nclick_check=1

Reporter Tom Loftus can be reached at (502) 875-5136.

Some states to partner with HHS on insurance exchanges

October 08, 2012 | Mary Mosquera

Government Health IT

 

WASHINGTON – A number of states will partner with the federal government to get their health insurance exchanges up and running, at least initially, because they were unable – for political or timing reasons – to get authority or plans ready by an imminent deadline.

States must send their blueprints for putting health insurance exchanges in place to the Department of Health and Human Services by Nov. 16.

“We have 14 governors who have sent in letters to the secretary that they are planning to establish an exchange in their state, and we’re actively working with those states and others to complete the requirements to be approved to be a state-based exchange,” said Amanda Cowley, director of state health exchanges in HHS’ Center for Consumer Information and Insurance Oversight (CCIIO). HHS will announce the exchanges in early January.

To make sure that states have adequate financing to build their exchanges, HHS has provided 34 states and the District of Columbia with significant exchange establishmentgrants. Seven of the financing grants are multi-year and aim to cover the full cost of the exchange construction and implementation. Those went to Rhode Island, Washington, Connecticut, Maryland, Nevada, Vermont and D.C. 

Exchanges will take one of three forms: state-based, state/federal partnership around claims management or consumer assistance or both, and federally facilitated, Cowley said.

“State-based exchanges, we believe, are the best models for states because of the flexibility they are given under the law,” she said at an Oct. 5 conference sponsored by America’s Health Insurance Plans (AHIP).

Under the Patient Protection and Affordable Care Act, coverage will be available through the exchanges in all 50 states on Jan. 1, 2014.

In a state-based exchange, states operate and have oversight over all exchange activities and functions, including certifying health plans, developing and launching consumer outreach campaigns, determining eligibility, establishing enrollment for insurance portability programs, coordination with other insurance affordability programs, as well as tax subsidies and building and owning their IT platform.

[See also: Northrop Grumann steering big data analytics toward health agencies.]

“We recognize that most states will ultimately want to operate their own state-based exchange but some states will need more time to build the necessary infrastructure to run their own,” said Cowley.

In the interim, they may choose to work as a state partner with HHS. In a claims management partnership, the state is responsible for all decision around health plans and issuers on its exchange, including selection and certification of qualifiedhealth plans, recertification and de-certification of health plans, data collection and transmission and issue oversight management.

In the consumer assistance partnership, the state partner takes the lead in assuring the availability of in-person assistance to individuals, including support for individuals filling out and submitting applications, comparing and selecting qualified health plans and enrolling in coverage.

“We know that states are skilled at performing activities like these. It’s the bread and butter of many of their government agencies do today,” said Cowley.

The state/federal partnership enables states “to continue to perform some of what we consider their most important roles and to help assure a more tailored and high quality experience for consumers in the state, even though those states perhaps aren’t quite ready for state-based exchanges,” she added.

Arkansas is one of the states planning for a state partnership exchange. Arkansas has many individuals earning low per capita income, adults with chronic diseases, and a large and growing percentage of uninsured individuals, said Cynthia Crone, exchange partnership director, for the Arkansas health benefit exchange.

“We have a real problem that the exchange helps us to move towards solving,” she said.

But it hasn’t been easy.

Republicans in the state legislature held up the budget and authority to begin planning for an exchange, and the Democratic governor did not want to do an end run around the legislature with an executive order. Ultimately, a budget passed, but time was limited. HHS recently awarded Arkansas with a planning grant to move toward the partnership model, Crone said.

[See also: HITsm: How do providers start?]

Arkansas consumer assistance will work closely with the federal navigator program to assure aseamless experience and little confusion for consumers. The state will contract for in person assisters to move people toward enrollment and will have a strong role for brokers and agents.

The state anticipates getting policy decisions and processes defined by the end of the year, place requests for proposals for consumer assisters in early 2013 with awards in May and starting to educate consumers in the summer about enrollment, which will start in October 2013, she said.

While Arkansas selected its essential health benefits benchmark and set timelines for qualified health plans certification, the federal government will perform more of the administration and plan management activities.

A small number of states may choose not to operate a state-based exchange or a partnership, Cowley said. In these states, HHS will establish and operate a federally facilitated exchange.

The Centers for Medicare & Medicaid Services is developing the infrastructure, and it will be able to perform all of the major functions of an exchange – claims management, eligibility and enrollment activities, consumer assistance, premium tax credit calculation and financial management, such as payments to issuers, she said.

 

Link: http://www.govhealthit.com/news/some-states-partner-hhs-insurance-exchanges

Health care law providing work for local companies

The Washington Post

By Marjorie Censer, Published: October 7

Local contractors are winning new work building health insurance exchanges and linking insurers into those networks as states move forward on the Obama administration’s Patient Protection and Affordable Care Act.

Reston-based Maximus, for instance, this summer started designing and developing Minnesota’s health insurance exchange. Under the $41 million, nearly two-year contract, the company is to create the technology for the exchange, meant to give Minnesota residents a way to shop for and enroll in health insurance plans.

Accenture, which has multiple local offices, won a $359 million contract to implement California’s health insurance exchange. About half of the funding will cover initial development and implementation, and the other half will go to operating costs over about three and a half years after implementation.

While some states are moving slowly, and in some cases opting to use a federal exchange initially, Bruce Caswell, president and general manager of health services at Maximus, said his company is expecting gradual increases in new opportunities.

“In the near-term, the addressable market at a state level is limited,” he said. But “that market will grow over time.”

A Reston-based company called hCentive, founded in 2009, is finding that building health insurance exchanges themselves is just the beginning.

Once hCentive develops and builds those, it then is going to insurance companies and helping them build the software they need to be able to connect with those exchanges.

With hundreds of insurance companies and a different health insurance exchange program in each state, the opportunities are nearly endless, said Sanjay Singh, hCentive’s chief executive andco-founder.

The company has already won work building health insurance exchanges for Colorado, New York and Massachusetts, he said.

Exchanges are gaining speed and attention. In the District, for instance, the D.C. Health Benefit Exchange Authority last week accepted a recommendation that would affect small businesses with 50 or fewer employees, requiring that they buy their health insurance plans through thecity’s exchange.

States are taking different approaches to their health insurance exchanges — some are purchasing technology and services as a package while others are buying each piece separately — and are moving at different paces, creating a whole range of opportunities, said Amanda White, an analyst at Deltek, which researches the government contracting market.

There are also contracts for marketing, consumer outreach, manning call centers and quality assurance.

“The breadth of opportunities is so wide that it’s not just system integrators” pursuing this work, White said. “It just reaches a very wide group of vendors.”

While the deadline for states to get exchanges up and running is 2014, White said these consumer-focused marketing efforts should get off the ground in 2013 and 2014.

Caswell said the move to health insurance exchanges is also changing the ecosystem for health technology, setting thestage for further health modernization.

“Gone are the days when states can rely on a caseworker-based model for providing these services,” he said. “Exchanges are just the beginning.”

 

Link: http://www.washingtonpost.com/business/capitalbusiness/health-care-law-providing-work-for-local-companies/2012/10/05/67d85754-08e1-11e2-afff-d6c7f20a83bf_story.html

DC to merge individual insurance market with small businesses under new health care law

By Associated Press, Published: October 6

WASHINGTON — Small businesses in Washington will be required to buy employee health insurance through a city-run exchange beginning in 2014.

The District of Columbia is combining its health care exchange markets for individuals and small businesses that have fewer than 50 employees. The D.C. Health Benefit Exchange Authority voted unanimously Wednesday to combine the health exchanges, despite opposition from businesses. Some said the exchange will lead to higher costs.

D.C. officials say the decision was based on the city’s small individual-insurance market. The city has few uninsured people. So D.C. Councilmember David Catania says the merger will create a sufficient pool for the health care exchange to bring down costs.

One state, Vermont, is taking a similar approach. Other states have more uninsured people and larger populations.

Copyright 2012 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

 

Link: http://www.washingtonpost.com/local/dc-to-merge-individual-insurance-market-with-small-businesses-under-new-health-care-law/2012/10/06/15e7f88e-0fe7-11e2-ba6c-07bd866eb71a_story.html

Health Insurance Exchange Spending Hits $2 Billion

Health Insurance Exchange Spending Hits $2 Billion

Latest round of grant awards will go toward building the IT infrastructure necessary to make state exchange websites operational.

 By Nicole Lewis InformationWeek

October 03, 2012 02:12 PM

 

The federal government has spent $2.2 billion to help states establish their health insurance exchanges, which require creating websites to let millions of small businesses and individuals in every state buy health insurance from qualified health plans.

Spending to establish these state exchanges, which must be operational by Jan. 1, 2014, exceeded the $2 billion mark with the announcement last week that Arkansas, Colorado, Kentucky, Massachusetts, Minnesota, and the District of Columbia will receive a new round of Exchange Establishment grants totaling $224 million.

The total amount awarded to date in both Level One and Level Two Exchange Establishment grants is $1,899,469,108. The amount awarded to date in Exchange Innovator grants is $249 million, and the total awarded in Exchange Planning grants is $49 million.

In May, the U.S. Department of Health and Human Services (HHS) said it had spent $1 billion over a two-year period toward establishing state insurance exchanges. Since then, grants totaling nearly $1 billion were announced after a U.S. Supreme Court decision in June upheld the constitutionality of the Patient Protection and Affordable Care Act. In August, HHS announced that California, Connecticut, Hawaii, Iowa, Maryland, Nevada, New York, and Vermont would receive a total of $765 million in grant funds for their exchanges. The additional $224 million announced last week means that federal spending on HIXs this year nearly equals the amount spent in the previous two years.

“I think the support the federal government has shown is indicative of the opportunity and the challenges of updating, redesigning and rebuilding entire technology systems to facilitate healthcare reform,” said Dr. Jay Himmelstein, professor in the department of family medicine and community health at the University of Massachusetts Medical School (UMMS), and co-author of the report, Establishing the Technology Infrastructure for Health Insurance Exchanges Under the Affordable Care Act.

Several states have indicated that the latest round of grant awards will go toward building the IT infrastructure necessary to make their exchange websites operational. For example, Arkansas will use its $18.6 million to continue work to design and implement automation to connect Arkansas Medicaid, and appropriate state-run exchange functions, with the federally-facilitated Exchange Eligibility and Enrollment portal. Funds also will go toward the design, development, and implementation of operations and information systems to support state-operated federally-facilitated Exchange Consumer Assistance functions including outreach, education, and the Navigator Program.

Minnesota’s $42.5 million grant will help the state continue to fund development of itsexchange information technology infrastructure, which includes establishing a governance structure within the Minnesota Department of Commerce with full-time staff dedicated to the development of Minnesota’s exchange. State officialssaid the funds will pay for financial management and consulting for financial system development, third-party assessment of internal controls, and consultation contracts for program integrity, as well as IT security assessment and hardware and software requirements.

Colorado will use its $43 million grant to continue efforts to establish the services and systems to launch Colorado’s new health insurance exchange. Specifically, resources from this grant will provide the Colorado Health Benefit Exchange the resources to meet deadlines for certification, testing, and deployment of systems and operations.

In the latest round of funding, Arkansas, Colorado, Kentucky, Massachusetts, and Minnesota received awards for Level One Exchange Establishment Grants, which are one-year grants awarded to states to build Exchanges. The District of Columbia received a Level Two Exchange Establishment Grant, which is a multi-year grant awarded to states further along in building their exchanges.

InformationWeek Healthcare brought together eight top IT execs to discuss BYOD, Meaningful Use, accountable care, and other contentious issues. Also in the new, all-digital CIO Roundtable issue: Why use IT systems to help cut medical costs if physicians ignore the cost of the care they provide? (Free with registration.)

 

 Link: http://www.informationweek.com/healthcare/leadership/health-insurance-exchange-spending-hits/240008389

Federal government likely involved in 37 health insurance exchanges

By Kelley L. Allen

Posted: October 3, 2012

IFAwebnews.com

 More states than expected likely will involve the federal government in setting up health insurance exchanges, according to a report released Oct. 2.

 The deadline for states to report plans is Nov. 16; Washington, D.C. and 13 states have announced plans to run their own exchanges. PwC’s Health Research Institute’s report, Health Insurance Exchanges: Long on Options; Short on Time, projects that most of the remaining 37 states will have the federal government directly involved in setting up the plans. Eight have already chosen to have a federally facilitated exchange, while three have elected to divide duties in a state-federal partnership, according to the report.

The exchanges mark the biggest insurance expansion since Medicare in 1965, and represent a major business opportunity for the insurance industry. The market will translate to a $205billion in premiums by 2021 with 12 million Americans expected to begin enrollment in the exchanges next year, according to the report.

The analysis also found that almost one-third will gain coverage under Medicaid, 45% will shop on the exchange and almost a quarter will enroll in employee-sponsored plans. Most will enter the system relatively young, with a median age of 33 and a median income of about 166% of the federal poverty level.

Many of the newly insured likely will cycle between Medicaid and subsidized exchange coverage, which makes continuum of care a challenge, the report noted.

The size of the market will vary based on each state’s decision on whether to expand Medicaid eligibility to 138% below the federal poverty level.

The report also notes that insurers on the exchange likely will initially compete based on price. As the exchanges mature, health plans will have to differentiate themselves beyond price to retain and attract consumers.

 

Link: http://ifawebnews.com/2012/10/03/federal-government-likely-involved-in-37-health-insurance-exchanges/