Sunday, March 13, 2011

State Plans for Exchange

All states must establish a Health Insurance Exchange by 2014 or the federal government will establish an Exchange for the state. To accomplish the goal, the state of New Mexico was awarded one million in grant funding to plan and establish exchanges in the state with funding available through September 2011.

Specific issues are being addressed by legislators and stakeholders with thinking along these lines:

• Should two exchanges that would include an Individual Health Exchange and a Business Health Exchange be established or should the state just establish one exchange
• Should the exchange should be operated by the Feds, operated by a non-profit agency, be operated within a state agency, or join in a regional exchange with other states

To meet all the requirements, the Exchange has to:

• Provide standardized information on insurance products
• Make comparison shopping for insurance easy
• Centralize enrollment and screen individuals for Medicaid and then link to the Medicaid system
• Provide customer service and a call center
• Be able to transition between commercial and government programs
• Determine eligibility
• Determine the cost of coverage after tax and cost sharing
• Be able to enroll individuals and businesses into plans through standardized electronic forms
• Maintain customer confidentiality
• Enforce consumer protections

One of the major requirements in developing the Health Insurance Exchange requires the New Mexico Human Services Department to implement a replacement eligibility system capable of interfacing with the Health Insurance Exchange. The “Integrated Service Delivery (ISD2) replacement system will need to provide automated eligibility determinations, benefits delivery, plus provide for a case management system.

The RFP for the ISD2 System Replacement Project was issued in January 2011 requiring the system to be web-based, easily modifiable, flexible, and scalable to accommodate changing requirements and programs.

The scope of work in the RFP included acquiring proposed hardware, software, and development tools that may be required to implement, operate, and maintain the system plus obtain any professional services deemed necessary. An integrated Electronic Document Management hardware and software solution may be acquired in conjunction with the proposed system. The procurement will result in a single source award to a contractor and the use of subcontractors will be encouraged where appropriate.

For more information, go to