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September Exchange Board Meeting: Level I Establishment Grant, Legislative Update, IT Design Options

On Tuesday, the Exchange Board held their September meeting (agenda) in Sacramento. Both the attendees and the Board were pleased to welcome Peter Lee as the first Executive Director of the Exchange. Lee said a few words about his excitement to be back in California (after a 1.5 year gig with the Center for Medicare and Medicaid Innovation at the Centers for Medicare and Medicaid Services in Washington, DC) and his view of California as the leader in implementing an Exchange. He officially begins on October 17.

Pat Powers, Acting Administrative Officer for the Exchange, will remain active until the end of the year on a part-time contract.

The Board approved the updated Conflict of Interest Policy, the proposed 2012 calendar, and the requirement to selectively contract with CO-OPS (despite the NPRMs proposed construct to automatically deem CO-OPS eligible to participate in the Exchange).

Exchange Staff

Joe Munso, Retired Annuitant at HHSA, provided an update on Exchange recruitment as a part of the $39M Level I Establishment Grant recently received from the federal government. In August, the Board authorized $300,000 for one or more contracts for recruitment of remaining executive-level management positions. They have narrowed the candidates down to two firms and plan on making one or more awards. Munso presented three other solicitation approvals for procurement of IT consulting ($494,000), program integration ($580,000), and stakeholder consultation ($400,000) firms.  Munso explained that they have also entered into final negotiations with a vendor to create a business and operations plan (approved at the August meeting). The vendor has been involved in the Massachusetts connector and also has experience with IT systems. They will provide stakeholders with a presentation to share their plans for the Exchange once negotiations are finalized.

Legislative Update

As for the relevant legislation discussed at the July meeting, only one bill (AB 1296) remains on the Governor’s desk. AB 1296 (Bonilla) sets standards for streamlining eligibility and enrollment by creating a single application form for multiple entities.

Program Integration

Katie Marcellus, Assistant Secretary for HHSA, explained that the Board is working with state partners, including DHCS, DOI, DMHC, HHSA and MRMIB, on the eligibility and enrollment issues. They recently drafted a list of priorities (i.e. defining navigators) during one of their regular convenings.

Design Options

Pat Powers presented design options created as a result of internal meetings and stakeholder meetings. Priorities from stakeholder input were building confidence, consumer control, considering all perspectives, enabling live contact, providing status updates, ensuring consistent rules regardless of application method, and ensuring that the SHOP brings value to the marketplace. The goals of the program is a “no wrong door” service, cultural and linguistic appropriateness, and seamless transitions between programs. They hope to provide real-time eligibility determination that is accurate, private, and enables consumers to make informed choices.

The presentation included 3-4 options for the ITs design infrastructure. Each option had different visions for the Exchange’s relationship with current county systems, the MRMIB/Maximus System, and Qualified Health Plans. They propose who would be responsible for eligibility functions, plan enrollment, case maintenance and updating client indexes for the Exchange, MAGI Medi-Cal, non MAGI Medi-Cal and CHIP enrollees. These options include: Option 1 – Distributive, Option 2 – Partially Integrated, and Option 3 – Fully Integrated. Bill Obernessor, the Exchange’s IT consultant, cited Option #1 as making the most of current systems. A handout was provided with a fourth option, Integrated Partnership.

Strategic Visioning

Bobbie Wunsch, Pacific Health Consulting, presented the two options for the Exchange vision mission and values that they have been developing since July. The goal is to adopt a vision by the October Board meeting. The general consensus was that elements from each vision mission should be combined to create one strong, clear mission.

Comments on the Federal NPRM

The Board presented their consolidated letter from all state agencies to submit with their comments on the first set of proposed rulemaking (establishment of Exchanges and Qualified Health Plans and reinsurance, risk corridors and risk adjustments). There was only one discrepancy in feedback from the Insurance Commissioner (technical issues related to risk). The deadline to submit comments was extended from September 28 to October 31. Many groups stated that they would still like to submit comments.