Reasonable Consideration Act AMERICAN Medical advantage Trades.


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Trade BASICS. State Based Individuals and little business workers discover and analyze protection optionsSmall Business Health Options (SHOP)IndividualsMay be combinedHelp follow individual mandateMust be up and running Jan. 1, 2014. Trades MUST. Confirm
Transcripts
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Moderate Care Act AMERICAN HEALTH BENEFIT EXCHANGES Delaware Health Care Commission October 7, 2010

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EXCHANGE BASICS State Based Individuals and little business workers find and look at protection choices Small Business Health Options (SHOP) Individuals May be joined Help agree to individual order Must be up and running Jan. 1, 2014

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EXCHANGES MUST Certify "qualified wellbeing arranges Toll free phone number Web website with institutionalized, near data on wellbeing arrangement alternatives Provide representatives decision of arrangement choices Electronic adding machine to decide cost and measure of any premium expense credit

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EXCHANGES MUST Provide starting and yearly open enlistment periods Assign evaluations to plans on relative quality and value Inform shoppers of Medicaid/CHIP qualification and select if qualified Use uniform enlistment structure

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EXCHANGES MUST Certify any exclusion from individual order Notify US Treasury of those absolved Information to bosses on workers who stop scope in qualified wellbeing arrangement Publish expenses of authorizing, administrator costs, cash lost to extortion/misuse

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EXCHANGE MUST Establish Navigator program Educate purchasers Facilitate enlistment Referrals to customer help program Consult with partners, including Educated human services buyers Entities w/involvement in encouraging enlistment Small business & independently employed Medicaid Advocates for selecting hard to achieve populaces

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STATES DECIDE Establish a state-based Exchange Join in a provincial Exchange with different states Allow US DHHS to work an Exchange inside a state How to oversee protection markets Merge non-gathering and little gathering? Arrangement conduct all through the Exchange

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STATES DECIDE Where the Exchange lives Within existing state office? Another different state office? Semi state office? Private non-benefit More on this later… ..

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STATES DECIDE How Exchange is administered State Employees of existing or new state organization? (Utah) Overseen by a free board? (Mass) Who names Board Relevant experience of Board Transparency of exercises Relationship and appropriateness of state managerial procedures

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STATE CONSIDERSATIONS Roles of different state offices in the Exchange IT needs and IT offices Medicaid/CHIP qualification/enlistment Insurance data and Dept. of Insurance How merchandise and administrations will be acquired How crossing point between Exchange items and open projects work

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IT CONSIDERATIONS Interface with Medicaid/CHIP Ability to select those qualified into Medicaid/CHIP Ability to recognize endowments for purchasers who qualify Web entrance outline Standard arrangement to look at cost & quality Data exchange to IRS

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SCOPE AND FINANCING what number lives will enlist in the Exchange? What number of arrangements will be offered in the Exchange? What is the genuine way of little gathering and non-bunch markets in DE? By what means ought to the Exchange account itself? Must act naturally adequate by 1/1/15

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KEY DATES Sept. 2010 Award of arranging gift Spring 2011 Notice – Implementation Jan.1, 2013 States advise; Sec\'y HHS chooses if will be ready 1/1/14 Jan. 1, 2014 State Exchanges become operational

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EXCHANGE GOVERNANCE OPTIONS Affordable Care Act says almost no: "An Exchange might be an administrative office or charitable element that is set up by a State." Options to be weighed through arranging process; DHCC choices critical

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STATE AGENCY Existing or new What the Exchange will do may drive choice "Business sector coordinator" Active buyer Use obtaining to drive framework change E.g. Change how arranges repay suppliers

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STATE AGENCY ADVANTAGES Direct connection to other state regulatory exercises Enhanced capacity to facilitate with other state exercises May work better with "business sector coordinator" approach Potential to organize with other state wellbeing acquiring techniques

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STATE AGENCY DISADVANTAGES Unlikely that any one state organization has skill important to work Exchange Medicaid needs ability in protection market Dept. Ins essential part administrative, not showcasing State worker advantage offices need learning of little and non-bunch markets

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STATE AGENCY DISADVANTAGES Active buyer Exchanges may should be agile and move rapidly Procurement may back off procedure Employment standards may put limits on contracting systems Close vicinity may make choices be politicized

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QUASI-GOVERNMENT OR INDEPENDENT AGENCY Advantages Possible exception from obtainment directions Possible exclusion from faculty controls Less potential for choices to be politicized Board structure can bring wide assortment or abilities and perspectives; access to business skill

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QUASI-GOVERNMENT OR INDEPENDENT Disadvantages Potential difficulties speaking with state offices May require additional time and assets for start-up Without cautious thought of Board organization irreconcilable situation issues emerge

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PRIVATE NON-PROFIT Advantages: Greater adaptability in basic leadership Less Chance for legislative issues to impact Disadvantages Isolation from state gov\'t exhibits transporters to coordination/correspondence Potential legitimate issues if Exchange performs government capacity (qualification for Medicaid)

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