Tuesday, January 22, 2013

Nevada's Exchange Strategy

According to the Kaiser Family Foundation, in 2011, there were 588,000 uninsured people in Nevada under the age of 65, representing 25 percent of that population. The state’s staff estimates that approximately two-thirds will be eligible for Medicaid with the remaining to become eligible for coverage through the Silver State Health Insurance Exchange.

Nevada’s Tribal community plays a vital role in the development of the Exchange. There are 19 federally recognized Tribes comprised of 28 separate Tribal bands, and community councils in Nevada. Representatives from the Indian Health Board of Nevada, the Washoe Tribal Health Center, and other tribal organizations have participated in the community stakeholder meetings. The State plans to further engage the Tribes in the planning process, mainly through the Indian Health Board of Nevada.

The state in developing Nevada’s Insurance Exchange is faced with challenges in terms of educating and enrolling the eligible population, expanding state services to absorb the Medicaid population, shifting costs, providing enough providers, and facing other market disruptions that may produce potential adverse effects.  

Today, plans for Nevada’s Exchange are well underway and the state is looking at how to address and really serve and connect with state residents. The system has been designed to enable residents to have direct input into the creation of the Exchange, to provide for a friendly business environment for Nevada’s small businesses, to maintain regulatory control over the state’s insurance market, and ensure that Nevada’s voice is heard not only at the state level but also federally.

An Exchange Board was appointed in 2012 and the Board has taken over actual implementation activities but continues communication, consensus building, and team work that the Nevada Department of Health and Human Services had started. The Board has met thirteen times the Advisory Committees has made substantial recommendations to the Board.

In 2011, the first official staff member to become part of the Exchange was a Grants and Project Analyst. In 2012, an Executive Officer was hired, and IT Officer positions were filled in July 2012. The Interim Finance Committee approved an IT Analyst position in 2012 that needs to be filled and recruitment is currently underway.

The state has compiled a compendium of background research reports on the commercial insurance market along with information on publicly-subsidized medical assistance programs, along with data on the uninsured. The reports are going to be updated on an on-going basis.

To provide more information, a website at www.exchange.nv.gov  has been updated and contains the latest information on all news and documents related to health reform and the Exchange planning process. The public can access all of the Board and Advisory Committee meetings, agendas, and packets, as well as watch the meetings live via video conferences.

To move forward, the Exchange is planning a series of technical implementation meetings with Nevada’s insurance carriers to help familiarize carriers with the Exchange on-boarding process and to get input from the carriers to help the Exchange avoid potential pitfalls. An Exchange Summit may be scheduled for June 2013.

The technical infrastructure is moving forward and Deloitte has been hired as the vendor to design and build a HCR Eligibility Engine to be accessed by the Exchange for enrollment purposes. The eligibility engine will house all of the business rules to determine whether an individual is eligible for publicly subsidized programs or for subsidized or unsubsidized insurance through the Exchange.

The eligibility engine will be designed to communicate with the federal data hub which will gather information on income, citizenship, plus data from various federal agencies. In addition, the Exchange’s staff has been working with Xerox, Division of Welfare and Supportive Services (DWSS), and Deloitte to ensure that the operational implementation plan is synchronized with the IT implementation plan.

Some of the functions will be outsourced and others performed in-house or continued with current vendors. The Exchange has entered into contracts with Public Consulting Group, Milliman, CSG, and with Xerox State Healthcare LLC, and is negotiating several marketing and outreach contracts.

Source: Silver State Health Insurance Exchange: Fiscal and Operational Report—Released December 2012.