Dental & ACA Implementation Presented by: NADP Health Care Reform Task Force & Staff Date: Tuesday, September 11, 2012 Sponsors Gold United Concordia Companies, Inc. Silver Heartland Dental Care, Verisk Health, DenteMax, Stratose, Coastal Dental, Dentalplans.com Bronze Emblem Health, Ameritas, PPO USA, Delta Dental of CA, Aspen Dental Mgmt. Other Sponsors Pacific Dental Services A GENDA 3 • NADP Priorities • ACA Federal Guidance • ACA Calendar • State Exchanges • Federally-facilitated Exchanges • Member Perspective • Dental Plan Calendar • State Essential Health Benefits • Fees & Taxes • NADP Resources NADP P RIORITIES 4 • Equitable Treatment • Allowing separate medical and dental policies combined to meet the EHB outside Exchanges • Exchanges • Dental Appropriately Included • Essential Health Benefit • Valued & Affordable Pediatric EHB • Assessments on Plans • Tax Assessment & Exchange Fees • Oral Health • Support ACA Oral Health Provisions E T QUITABLE REATMENT 5 K NADP A NOWN CTIONS • • HHS acknowledged issue in Stabenow leadership continues Exchange Regs • Meeting with White House • TBD in EHB Regs (?) • • Letters from Senators to NAIC: Mkt. in & out of White House Exchange should be same • Pursuing ADA comment & • ADA, Business & potential NAIC support Congressional Support • Prep for alternative action if decision is unfavorable F G EDERAL UIDANCE 6 G R T B R “S ” UIDANCE ELEASED O E ELEASED OON • • EHB Benchmark Guidance EHB Regulations including • HIX Regulations Cost Sharing • No Limits • Additional HIX Regs • Relevant QHP certification • AV Specifications criteria apply to QDP • ST Decides on Transparency of • Plan Management / Dental Dental Certification Criteria (if Fed.) • HIX Blueprint for States • OPM: Multi-State Plans • SHOP Applications--DRAFT • IRS: Plan Assessment • Collection of Data—DRAFT • Market Reforms ACA T IMELINE 7 • 3Q: State to choose EHB benchmark • HIX to be Self Sufficient 2015 • Nov. 16: State to Submit HIX 2012 Blueprint to CCIIO • Small Employer Defined as •Jan: CCIIO to Announce Approval 100 & Fewer—All States 2016 of State Blueprints •1Q: CCIIO & States Qualify Health 2013 and Dental Plans •Oct 1: Enrollment begins in HIX • HIX Can Allow Large Employer 2016 • Individual Mandate in Effect • HIX Coverage Starts • Excise Tax On High Cost 2014 • Assessment Fee Collected Insurance (Dental Exempt) 2017 E M XCHANGE ODELS 8 S E TATE XCHANGES 9 WA ME* MT ND VT OR MN NH ID WI SD NY MA WY RI MI CT IA PA NJ NV NE OH DE UT* IL IN CA CO WV MD DC VA KS MO KY NC* TN AZ* OK NM AR SC MS AL GA AK TX LA HI FL 9 Green = State Base Exchange Yellow = State & Federal Partnership Red = Federally-facilitated Exchange QHP C S ERTIFICATION TANDARDS 10 Apply (partial) Modify Do Not Apply Child Only Plans Cost Sharing Limits Actuarial Values Individual Policies Quality Improvements Risk Adjustment No lifetime or annual max Rate Information & Same premium inside & Justification outside Exchanges No Discrimination Network Adequacy Accreditation Use of Community Providers Provider Information Abortion Coverage Processes for Payment, Enrollee Termination, etc. Enrollee Information Prescription Drug Licensing Coverage Marketing Exchange User Fees