Health Care ReformHealth Care Reform

Federal Legislation

In March 2010, Congress and the President enacted two bills: the Patient Protection and Affordable Care Act (PPACA), and the Health Care and Education Reconciliation Act of 2010. While some reform elements are already in effect, the majority of changes will be phased-in over time, concluding with the opening of state health insurance exchanges for individuals and small business in 2014. Once operational, state exchanges will provide venues for qualifying individuals to "shop" for quality, comprehensive health insurance plans at competitive rates.


State Health Care Exchanges:  Impact to CRCs

Individual state health care reform councils are currently evaluating and determining which services and corresponding service providers should be covered by insurers certified to offer their products on their state's exchange. During this critical stage, CRCC is proactively advocating for the inclusion of rehabilitation counseling for individuals with disabilities, with CRCs being the professionals qualified to provide those services.

March 2012
In December 2011, the United State Department of Health and Human Services (HHS) released a federal bulletin to provide guidance to states in developing Essential Health Benefits (EHBs) for inclusion in their state health care insurance exchanges.  Determination of EHBs is critical as they will set the minimum benefits required of all health plans purchased through state health insurance exchanges, as well as individual and small employer plans purchased outside of the exchanges. While the HHS bulletin noted current coverage trends concerning habilitative services, there was no inclusion, nor discussion, of rehabilitative services. It is critical that states be alerted as to the vital importance of rehabilitative services and rehabilitation counseling so they may give due consideration to its inclusion in their determination of Essential Health Benefits.

July 2011
The United States Department of Health and Human Services (HHS) issued a Notice of Proposed Rulemaking setting guidelines for the creation of State Health Benefit Exchanges and a process for federal approval of those exchanges.  The Proposed Rules allow for states to organize the governance of their exchange as an independent public entity, a separate state agency, or as part of an existing state agency.


Active State Discussions and Policy Groups

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Alabama

Alabama Department of Insurance Stakeholder Meetings
April 2012

The Department of Insurance is holding meetings regarding health care reform implementation in the state, most recently in December 2011. The meetings were chaired by the Insurance Commissioner, Jim Ridling or a member of his staff and focused around generating input from stakeholders in four areas of exchange implementation: 1) Enrollment and Consumer Assistance; 2) Exchange Administration; 3) Qualified Health Plan Administration; and 4) IT and Technology Requirements. The Department of Insurance will utilize the information from stakeholders in its design and implementation of the exchange. 

Alaska

Alaska Health Care Commission
April 2012

The Alaskan Health Care Commission is chaired by Dr. Ward Hurlburt, Chief Medical Officer for the Alaska Department of Health & Social Services. The Commission's 11 voting members include hospital directors and administrators, health insurance executives, non-profit leaders, doctors, community health center directors, health care providers, and other individuals with expertise in Native American, veteran, and family health issues. The Commission also has three non-voting members: Linda Hall, Director, Division of Insurance, Alaskan Department of Commerce, Community and Economic Development; Representative Wes Keller (R); and Senator Donald Olson (D).

The Commission will receive briefings on Health & Health Care in Alaska and federal health care reform and the status of impact analyses and implementation activities in Alaska. The Commission will also identify their interests and concerns regarding health care in Alaska and determine goals for a 2010 Commission Report to the Governor and Legislature by 1) Identifying gaps in knowledge about Alaska's health care system; 2) Identifying highest priority system transformation strategies; and 3) Identifying measures for tracking progress of Alaska's health care system.

The draft report is available online.  View 2011 Findings and Recommendations.  The next meeting will be held on June 14-15, 2012.

Arizona

Check back for future activity updates.

Arkansas

Health Benefits Exchange Planning Division Steering Committee and Workgroup Meetings
April 2012

The Health Benefits Planning Division is contained within the Department of Insurance. The Division was created through a grant provided by the Office of Consumer Information and Insurance Oversight and the U.S. Department of Health and Human Services. The purpose of the Division is to plan and implement a health benefit exchange in accordance with the Patient Protection and Affordable Care Act. A Steering Committee and six workgroups have been established to assist with planning and implementation. The workgroups are focused in the following areas: (1) Consumers; (2) Information Technology; (3) Community leaders; (4) Outreach/Education/Enrollment; (5) State Agencies; and (6) Providers.

The Department of Insurance received a $1 million exchange planning grant from the Department of Health and Human Services and has used this grant to establish the Health Benefits Exchange Planning Division (Division). The Division, with Cynthia Crone as the Director, established a Steering Committee and work groups to assist with planning and implementation of a health insurance exchange. However, the Steering Committee's recommendation and all future meetings have been cancelled. In lieu of developing its own exchange, Arkansas has instead, opted to operate an exchange using the Federal Partnership Model. Under this Model, Arkansas can perform insurance plan management functions and consumer assistance functions. As part of planning for the Federal Partnership Model, the Division has issued RFPs (Request For Proposal) for a Quality Health Program Specialist and for a consultant to develop Arkansas' Navigator Program.


California

California Health Benefit Exchange Governing Board
April 2012

The Health Benefit Governing Board was established by legislation in 2010 and became effective January 1st, 2011. The Board members are all appointees. Two were appointed by Governor Schwarzenegger - Susan Kennedy, his former chief of staff, and Kim Belshé, the former Secretary of Health and Human Services. By statue, the third member is the current head of Health and Human Services, Diana Dooley. The Assembly Speaker named Paul Fearer as the Fourth member of the Board. The Senate President has appointed the final member of the Board, Robert Ross, M.D.

At the December 20th, 2011 meeting, the Board discussed Information Technology and Small Employer Health Care Decision Making in California. In addition, the Board announced the draft solicitation to acquire the service of a contractor to design, develop, and deploy functionality to meet the requirements of the Affordable Care Act relating to the Exchange, Medi-Cal, and Healthy Families. Comments on this document were due 12/30/2011. On January 31st, 2012, the Board submitted comments, along with other state agencies, on the Essential Health Benefits Bulletin. The most recent meeting was held on March 22nd, 2012 where the Board discussed the federal Final Rule on Establishment of Exchanges and Qualified Health Plans and Enrollment Efforts through panel presentations.  View CA Materials

Colorado

Colorado Health Reform Implementation Board
April 2012

Governor John Hickenlooper gave the State of the State speech on January 12th, 2012 addressing Colorado's commitment to quality health care and development of the Colorado Health Benefits Exchange. A copy of the address is available online.  View Colorado State of the State Address

Colorado Health Insurance Exchange (CHIEX) Board
April 2012

In May 2011, the Colorado General Assembly adopted Senate Bill 11-200, creating a process for implementation of a Health Benefit Exchange in Colorado as an independent public entity not affiliated with an existing state agency or department, and establishing a Board of Directors to govern the Exchange made up of members appointed by both the Governor and the Legislature. The Board, which generally holds monthly meetings, named Patty Fontneau as the new Executive Director and Chief Executive Officer of the Colorado Health Benefit Exchange (COHBE). While staff have been discussing decisions needed to develop the CHIEX, Workgroup updates were the topic of discussion at the March 12th meeting. The Education, Outreach/Marketing Workgroup will meet next on April 18th, 2012.

Connecticut

Connecticut Governor's Health Cabinet
April 2012

The Health Care Cabinet was established by Public Act No. 11-58, Section 14. It was established within the Office of the Lieutenant Governor for the purpose of advising the Governor and the Office of Health Reform and Innovation (followed at CT19584). The Lieutenant Governor will serve as the chairperson of the Cabinet. The Cabinet is charged with developing a strategy that applies national health care reform building upon Connecticut's successful health care programs to ensure that Connecticut's residents and businesses realize the benefits of national health care reform.  It will also pursue federal funding and/or foundation funding opportunities to assist in developing the exchange and implementing any other aspects of health care reform. Cabinet meetings on March 13th and April 10th included updates concerning the Consumer Advisory Board, Health Technology, Delivery System Reform, and Business Plan Development.

Connecticut Health Insurance Exchange Board
April 2012

The Connecticut Health Insurance Exchange Board of Directors (Board) will oversee the development and implementation of the Connecticut Health Insurance Exchange, a quasi-public authority. Both the Exchange and the Board are mandated by federal law and created pursuant to state legislation, Public Act No. 11-53 (referenced at CT18125). The Board will be composed of 14 members. Eleven Board members will have voting rights, including three from the Executive Branch.  The Executive Branch members will be: 1) Jeannette DeJesus, the Special Advisor to the Governor on Health Reform; 2) Commissioner Roderick Bremby from the Department of Social Services; and 3) Secretary Benjamin Barnes from the Office of Policy Management. The Governor will appoint two members of the Board, and legislative leaders will appoint the remaining six. The Governor will name a Chairperson for the Exchange. There are also three ex-officio non-voting members: Vickie Veltrie as the Healthcare Advocate, Commissioner Jewel Mullen of the Department of Public Health, and Commissioner Thomas Leonardi of the Connecticut Insurance Department. The Board meets on a monthly basis - its next meeting is April 19th.

Connecticut Office of Health Reform and Innovation
April 2012

The Office of Health Reform and Innovation was established to coordinate the work of the State around health reform implementation. Located in the State Capitol Building, it will have one staff member and, in consultation with the Governor’s Cabinet, will convene a consumer advisory board that consists of at least seven members. The State is also a member of the consortium of New England states awarded a federal "Early Innovator" grant to help with the design and implementation of the information technology infrastructure needed to operate a health insurance exchange. In addition, the Office of Health Reform and Innovation will convene a working group to develop a plan to implement a statewide multi-payer data initiative to enhance the state's use of health care data from multiple sources. The goals of the initiative are to increase efficiency, enhance outcomes, and improve the understanding of health care expenditures in the public and private sectors. The Office held meetings on February 17th and March 21st and has not yet scheduled additional meetings.

Delaware

Check back for future activity updates.


District of Columbia

District of Columbia Health Reform Implementation Committee
September 2011

Established by Mayor's Order in 2010, the Health Reform Implementation Committee oversees the implementation and coordination of health care reform. The four cabinet members are Commissioner Gennet Percell (co-chair) of the Department of Insurance, Securities, and Banking, Dr. Julie Hudman (co-chair) of the Department of Health Care Finance, Dr. Pierre Vigilance of the Department of Health, and Clarence Carter of the Department of Human Services. The Committee began meeting in May 2011. At its initial meetings, The Committee discussed the goals of the Exchange and governance of the Exchange, as well as facilitating stakeholder input. The next Committee meeting has not been announced.


The Committee created five sub-committees to review various issues pertaining to the implementation of health care reform: 1) Health Insurance Exchange Sub-Committee; 2) Consumer Outreach Sub-Committee; 3) Delivery System Reform Sub-Committee; 4) Insurance Regulations Sub-Committee; and 5) Medicaid Expansions Sub-Committee. There are no sub-committee meetings scheduled at this time.

The Health Insurance Exchange Sub-Committee will conduct analysis of how the District's Exchange could be structured to best achieve expanded health insurance access, education, information and affordability.

The Consumer Outreach Sub-Committee is responsible for providing information about how reform will affect various stakeholders and how they might participate in the implementation process.

The Delivery System Reform Sub-Committee will coordinate the opportunities for pilots, demonstration projects, and other mechanisms to test and evaluate delivery system changes designed to improve quality and control costs. The Sub-Committee will work to identify new opportunities and maintain focus on delivery system changes that result in improved health outcomes and reduced costs.

The Insurance Regulations Sub-Committee is responsible for researching and providing guidance to the Committee on legislative, regulatory, and policy changes to implement health reform.

The Medicaid Expansions Sub-Committee is tasked with developing and implementing the Medicaid expansion that was included within health care reform.


Florida

Check back for future activity updates.


Georgia

Georgia Exchange Advisory Committee
April 2012

The Exchange Advisory Committee, led by the Governor's Office and is comprised of various stakeholder groups, is a working group to assess the feasibility of establishing a state run health benefit exchange. The Committee is comprised of a diverse group of stakeholders, including healthcare providers. In addition to its meetings, the Committee held several stakeholder meetings throughout the state to receive input from the public - the final Committee meeting was on October 25th, 2011. The final report, submitted in December 2011, supports development of a small business health insurance marketplace which (1) is outside of the context of PPACA-prescribed AHBE and SHOP Exchange requirements; (2) is orchestrated through private or limited quasi-governmental means; and (3) focuses on private-sector free-market principles.  View Final Report


Hawaii

Hawaii Health Connector
April 2012

The Hawaii Health Connector, established by SB 1348, is responsible for: (1) facilitating the purchase and sale of qualified plans and qualified dental plans; (2) connecting consumers to the information necessary to make informed health care choices; and (3) enabling consumers to purchase coverage and manage health and dental plans electronically. SB 1348 also established the governing structure for the implementation of the exchange, creating a Hawaii health insurance exchange council under a board of directors and a task force to recommend policies and procedures to implement the governance of the health insurance exchange.

During the formation of the Connector, the legislation allowed for an Interim Board to create the structure for the Connector. The Governor appointed the following to the Interim Board:
  • Sherry Menor-McNamara, Chair (Vice-President of Business Advocacy & Government Affairs, Chamber of Commerce of Hawaii);
  • Robert Hirokawa, Vice-Chair (Chief Information Officer, Hawaii Primary Care Association);
  • Cliff Alakai, Treasurer (Administrator, Maui Medical Group);
  • Joan Danieley (Vice-President, Health Plan Service and Administration, Kaiser Foundation Health Plan, Inc.);
  • Jennifer Diesman (Vice-President, Government Relations, Hawaii Medical Services Association);
  • Kenneth Fink, MD (Director, Med-QUEST Division, Hawaii Department of Human Services);
  • Beth Giesting (Health Care Transformation Coordinator, Hawaii Office of the Governor);
  • Michael Gleason (President and Chief Executive Officer, The Arc of Hilo);
  • Gordon Ito (Insurance Commissioner, Hawaii Insurance Division);
  • John McComas (Chief Executive Officer, AlohaCare);
  • Mary Oneha (Chief Operating Officer, Waianae Coast Comprehensive Health Center);
  • Gwen Rulona (Director of Education and Legislation, UFCW Local 480);
  • Christine Sakuda (Executive Director, Hawaii Health Information Exchange);
  • Johnrae F. Christian (Disability Compensation Division Programs Chief for PrePaid Health Care Act and Temporary Disability Insurance).

The Interim Board released a report on the Hawaii Health Connector, detailing the guidelines and proposed time frame for the implementation of the Connector.


Idaho

Idaho Health Care Task Force
September 2011

The legislature's Health Care Task Force has been meeting to hear testimony on various aspects of federal health care reform. Specifically, the Task Force has heard from the Idaho Department of Insurance, the Department of Health and Welfare, and the High Risk Insurance Pool Board on the impact of federal health care reform on department specific activities. The Task Force has also heard from Blue Cross Blue Shield on health care reform's impact on products, rates and policies. The Office of the Attorney General has spoken to the Task Force on the status of Idaho's lawsuit on federally mandated health insurance. The Task Force, co-chaired by Senator Dean Cameron (R) and Representative Gary Collins (R), last met in January 2011.  The 2011 legislative session adjourned without the introduction of Exchange legislation. The Task Force has no future meetings scheduled.

Illinois

Illinois Health Care Reform Implementation Council
September 2011

The Health Care Reform Implementation Council was formed by Executive Order in 2010 to implement health care reform in Illinois. The Council was charged with making recommendations to assist the state in establishing a health insurance exchange and other consumer protection reforms; reform Medicaid; and foster the widespread adoption of electronic medical records. The Council submitted its first report March 1st, 2011 which included several recommendations on the exchange implementation and Medicaid expansion. The Council has not scheduled additional meetings and has no timeframe for its next report.

Illinois Department of Insurance Exchange Working Groups
September 2011

The Department of Insurance established four working groups to involve similarly situated stakeholders in various aspects of the exchange. The working groups each held one meeting in Winter 2010-2011. No additional meetings were held and none are currently scheduled.

The Exchange Governance Working Group is reviewing broad considerations of exchange governance from the employer's perspective.

The Long-Term Sustainability Working Group is looking at ways to ensure the exchange is developed to ensure its long term success and has received the perspective of patient and family advocates, producers, employers, insurers, and providers.

The Exchange Operating Model Working Group is considering different models of how to structure the exchange and has received the perspective of patient and family advocates, producers, employers, insurers, and providers.

The Exchange Enabling Legislation Working Group is developing the legislation which will ultimately be introduced in the Illinois Legislature to establish the state exchange.

Indiana

Indiana Health Finance Commission
September 2011

Comprised exclusively of members of the Indiana Legislature, the Commission held its first meeting to discuss Exchange implementation on July 13th, 2011. It heard reports on the types of Exchange that is being considered for implementation in Indiana, as well as the plans to include stakeholders in the implementation process. The Commission last met on September 28th, 2011. 

Indiana Select Joint Commission on Medicaid Oversight
September 2011

Governor Mitch Daniels (R) issued an executive order authorizing the Family and Social Services Administration to work with the Department of Insurance and other state agencies to conditionally establish and operate a state-based health insurance exchange as part of the implementation of the Patient Protection and Affordable Care Act (PPACA). An interagency task force comprised of members of the Governor's Office, the Family and Social Services Administration, and the Department of Insurance has been formed to discuss the various components of the PPACA. The Commission met on August 23rd, 2011 to receive an overview of the development of healthcare reform and exchange planning.

Iowa

Iowa Health Care Reform Committees
April 2012

While the Health Care Reform Committees within the Department of Public Health were originally created to implement health care reform legislation passed in Iowa in 2008, they will now help with the implementation of the Patient Protection and Affordable Care Act. There are seven committees: the Direct Care Worker Advisory Council; the Electronic Health Information Advisory Council and Executive Committee; the Iowa Health Reform Prevention and Wellness Initiatives; the Health and Long-term Care Access Advisory Council; the Patient Autonomy in Health Care Decisions Pilot Project Advisory Council; the Medical Home System Advisory Council; and the Prevention and Chronic Care Management Advisory Council.  View Iowa Health Care Reform Committees website

The Prevention and Chronic Care Management Advisory Council met on April 12th to discuss Medicaid Health Care Reform Implementation, specifically addressing Duel Eligibility issues.  The Council will meet again on May 25th at the Iowa Hospital Association.

Kansas

Kansas Department of Insurance Workgroups
April 2012

The Department of Insurance established eight (8) workgroups to assist with the development of a helath benefits exchange. The workgroups will focus on the following issues: 1) Focus/Business Operations; 2) Governance/Legal/Legislative; 3) Background Research; 4) Consumer Outreach/Education/Information; 5) Insurance Market; 6) Funding/Financial; 7) Agents/Brokers/Navigators; and 8) Medicaid Integration and Interagency Communications. 

At the Training Subgroup of the Governance/Legal/Legislative Workgroup on April 6th, the subgroup received an update concerning the Kansas Insurance Department’s (KID) discussions about Exchanges with Health and Human Services.  Kansas KID staff have been appointed to lead plan management working groups established by the NAIC to create white papers that states can use when establishing state and partnership exchanges. 

Kentucky

Check back for future activity updates.


Louisiana

Louisiana Health Care Commission
September 2011

The Commission, created within the Department of Insurance, is responsible for reviewing and studying the availability of health care in Louisiana. It is tasked with the review of issues pertaining to the implementation of the PPACA, including Exchange implementation.  The Commission last met on August 26th, 2011. Governor Jindal has indicated, at present, that Louisiana will not create a state exchange.

Maine

Maine Health Reform Implementation Steering Committee

April 2012
The Committee was created by Executive Order and established the permanent membership to include the Director of the Governor's Office of Health Policy and Finance, the Commissioner of the Department of Health and Human Services, the Commissioner of the Department of Professional and Financial Regulation, the Superintendent of Insurance and the Executive Director of the Dirigo Health Agency. The Committee
heard presentations from the Advisory Council on Health Systems Development (ACHSD), the Joint Select Committee on Health Care Reform Opportunities and Implementation, and the National Academy of State Health Policy (NASHP), as well as the Federal Health Care Reform Options for MaineCare and CHIP. In addition it has been working with the National Governor's association and Federal officials to discuss how Dirigo will need to be altered for the PPACA. The Committee released its final report in December 2010 and is waiting for federal guidance to move foraward.

Maryland

Maryland Health Care Reform Coordinating Council
April 2012

Established by Governor O'Malley (D) when he signed into law a package of bills on April 12th, 2011, the Health Benefit Exchange (Exchange) is a public corporation and independent public entity that is governed by a board of trustees consisting of the Secretary of Health and Mental Hygiene, the commissioner, the Executive Director of the Maryland Health Care Commission, and six members appointed by the Governor and confirmed by the Senate. The Exchange is responsible for negotiating with carriers for affordable and qualified health plans for the exchange and assigning a rating for each qualified plan. The Exchange will also: (1) assist employers who qualify to have their employees enrolled in a qualified health plan; (2) create an implementation plan to show that the plan is ready to operate by January 1st, 2014; (3) establish and provide enrollment periods; (4) provide for a website that contains information about all of the qualified plans; (5) inform individuals of the eligibility requirements for health coverage and enroll those who qualify; and (6) grant certification for hardship cases to individuals who cannot retain the minimum essential coverage mandated by the Patient Protection and Affordable Care Act.

The Board’s April 10th meeting focused on the Individual Premium Billing Policy discussion.


Massachusetts

Massachusetts Stakeholder Meetings
April 2012

The group of agencies tasked with implementing health care reform in Massachusetts holds quarterly meetings, open to the public, where any stakeholder or general public member can attend and comment. A stakeholder meeting was held on March 12th - the next meeting has not been announced.

Michigan

Check back for future activity updates.


Minnesota

Minnesota Health Care Access Commission - Health Insurance Exchange Working Group

September 2011
The Minnesota Health Insurance Exchange Working Group is comprised of state legislators and members of the public. Senator Linda Berglin (DFL) and Representative (DFL) Paul Thissen chair the meetings. The Working Group has reviewed the functions of the health exchange, while listing potential additional functions to consider pertaining to other requirements of federal law and identifying similar functions currently being performed by state agencies/other organizations. Furthermore, the group has reviewed market rules and plan participation requirements, the risk pooling and adverse selection issues, provisions in the PPACA that mitigate adverse selection issues, and current Minnesota law affecting adverse selection including "qualified health plan" requirements. The next meeting of the Working Group has not been established.


Mississippi

Mississippi Health Insurance Exchange Advisory Board
April 2012

Insurance Commissioner Mike Chaney (R) stated that he has the authority to choose an entity to operate an exchange. He is drawing on his authority under the Comprehensive Health Insurance Risk Pool Association Act. He selected the Comprehensive Health Insurance Risk Pool Association to operate an exchange.  Pursuant to this authority, the Mississippi Health Insurance Exchange Advisory Board will provide advice, recommendations, and suggestions regarding the exchange. The Advisory Board and Subcommittees will meet at least quarterly. All meetings of the Advisory Board will be open to the public.

The Mississippi Health Insurance Exchange Advisory Board will meet on May 9th to discuss recommendations regarding essential health benefits, and again on June 13th to adopt final essential health benefits.

Missouri

Check back for future activity updates.


Montana

Montana Exchange Stakeholder Involvement Council
September 2011

The Securities and Insurance Commission (Commission) established the Exchange Stakeholder Involvement Council (Council) to receive input and recommendations from stakeholders regarding exchange implementation. Chaired by Commissioner Monica Lindeen, the focus of the Council meetings is to review and comment on the Commission's draft of HB 124, which establishes the exchange in Montana. Input and recommendations from stakeholders are being used by legislators to review and make additional changes to HB 124. The Council met on April 7th, 2011 in Helena. The date of the next meeting has not been established.

Montana Exchange Interagency Work Group
September 2011

The Securities and Insurance Commission established an Exchange Interagency Work Group to coordinate the construction and implementation of the health insurance exchange across state agencies. The Work Group is chaired by Monica Lindeen, Securities and Insurance Commissioner. Representatives from the Governor's Office, Legislative Services Division, Department of Administration, Department of Public Health & Human Services, and Indian Health Services are all participating. The Work Group reviewed and made comments on the Commission's draft of HB 124, the bill introduced in the Legislature to construct and implement the exchange. It has also discussed high level coordination of implementation between various agencies.  While the Work Group has continued to meet to discuss basics of Exchange implementation, the next meeting has not been announced.

Montana Economic Affairs Interim Committee
September 2011

The Economic Affairs Interim Committee is studying the feasibility of creating a state-based health insurance exchange or participating in a regional health insurance exchange. The Committee met on August 23rd and 24th. Marguerite Salazar, a regional director with the U.S. Department of Health and Human Services, told the Economic Affairs Interim Committee that the U.S. Department of Health and Human Services is working on a partnership model for an exchange.  

Nebraska

Nebraska LR 467 Select Committee
April 2011

The legislative Select Committee was created by LR 467, authored and chaired by Senator Tim Gay (I). The Committee is to study: 1) the effect of the federal Patient Protection and Affordable Care Act on Nebraska; (2) the role of employer-sponsored insurance and public programs in providing health care coverage for Nebraskans; and (3) available funding options to ensure a financially sustainable and affordable health care system.


Nebraska Department of Insurance Public Forums
September 2011

The Department of Insurance held public forums throughout the state to allow the public and stakeholders to comment on the implementation of the exchange. The Department of Insurance Director, Bruce Ramge, hosted the forums to promote an open and transparent implementation process with focus on the required planning and development of health insurance exchanges. Forums were held on March 16th and March 22nd, 2011. No additional stakeholder meetings are planned at this time.


Nevada

Nevada Health Care Reform Policy Planning Group
September 2011

The Health Care Reform Policy Planning Group, working toward the implementation of a health insurance exchange, is now focusing on IT development efforts to support implementation. Led by the Director of the Department of Health and Human Services, Mike Willden, other members include the Insurance Commissioner, the Administrator of the Division of Health Care Financing and Policy, and representatives from the Office of the Attorney General, the State Insurance Division, Risk Management, the Public Employees Benefits Program, the Governor's Office of Consumer Health Assistance, and the Division of Welfare and Supportive Services. The Planning Group met on July 21st, 2011 - the next meeting date has not been announced.


Nevada Health Care Reform Implementation Working Group
September 2011

The Health Care Reform Implementation Working Group was tasked with determining what effect the PPACA will have on Medicaid. It is now focusing on the creation of an eligibility engine for the health insurance exchange, rate enhancement, long-term care re-balancing, prescription drug rebates, and patient-centered medical homes. Led by the Administrator of the Division of Health Care Financing and Policy, Charles Duarte, other members include representatives from the Aging and Disability Services Division, the Division of Mental Health and Developmental Services, the Division of Health Care Financing and Policy, the Division of Welfare and Supportive Services, the Division of Child and Family Services, the State Health Division, and the Department of Health and Human Services Director's Office. The Working Group's next meeting has not been set.


New Hampshire

New Hampshire Health Insurance Reform Oversight Committee

September 2011
The Health Insurance Reform Oversight Committee, chaired by
Representative Ed Butler (D), has been meeting to discuss implementation of federal health care insurance. The Committee made a summary report on federal insurance reform implementation, together with any recommendation for legislation, to the House Commerce and Consumer Affairs Committee and the Senate Commerce, Labor and Consumer Protection Committee. The Committee has not set a date for its next meeting.



New Jersey

New Jersey Health Care Reform Implementation Council

April 2012
The New Jersey Assembly and Senate have passed A.B. 2171, which creates the New Jersey Health Benefit Exchange, its board of directors, and the creation of a Basic Health plan to cover people beyond Medicaid.  The bill, whose outcome is will likely be decided by the outcome of the Supreme Court challenge to the Affordable Care Act, should be sent to Governor soon.  Governor Christie has publicly announced his skepticism regarding the constitutionality of the provisions of the ACA, however he maintains that New Jersey will be positioned to implement the changes if the law is upheld by the Supreme Court.


New Mexico

New Mexico Health Care Reform Working Group

September 2011

The Health Care Reform Working Group, focused on federal health care reform and health insurance exchanges, was preparing a report for the Joint Legislative Health & Humans Service Interim Committee, and then the full Legislature. The working group last met on October 4th, 2010 to discuss information technology, broadband access, interface with Medicaid, quality, transparency, and reporting, and health insurance exchanges, as well as to obtain public comment. The Working Group was called to reconvene in the 2011 Legislative Session, however, due to state budgetary constraints, funding that allowed for legislative participation in the Working Group has been cut. No attempts have been made to reconvene the Working Group without legislative participation.  


New York

New York Health Care Reform Advisory Committee

September 2011
The Health Care Reform Advisory Committee was formed to provide input to the Governor's Health Care Reform Cabinet on reform provisions and to ensure stakeholder and public involvement. It includes 37 organizations representing health care providers, consumers, businesses, organized labor, local governments, health plans, health insurers, and health policy experts. The Advisory Committee will include work groups created to focus on specific issues. Advisory Committee meetings are not open to the public - the date of the next meeting has not been set.


New York Health Care Reform Cabinet

September 2011
The Governor's Health Care Reform Cabinet was created May 13th, 2010 by Governor David Paterson (D). The Cabinet was charged with managing the implementation of federal health care reform including:

  • Identifying deadlines for the completion of interim or final steps necessary to comply with federal health care reform;
  • Identifying provisions of federal health care reform with which the state must comply, those which are optional, and analyzing the participation in optional programs;

  • Assessing the state's capacity to carry out the provisions of federal health care reform that affect the state;

  • Identifying any changes needed to state statute, regulation, policy, or procedure in order to implement federal health care reform provisions;

  • Communicating with the federal government, local government, or other state health care providers and other stakeholders; and

  • Providing for outreach to the public to educate them on the implementation of reforms.


Cabinet members include representatives from the Department of Health, the Department of Insurance, the Division of the Budget, the Department of Civil Service, the Department of Taxation and Finance, the Department of Labor, the Office for Technology, the Office of Temporary and Disability Assistance, the Office of Mental Health, the Office of Mental Retardation and Developmental Disabilities, the Office of Alcoholism and Substance Abuse Services, the Office for the Aging, the Office of the Medicaid Inspector General, and the Office of Children and Family Services.  Other Cabinet members include the Deputy Secretary for Human Services, Technology and Operations, Deputy Secretary for Intergovernmental Affairs, and Counsel to the Governor. The Cabinet continues to meet, however meetings are closed to the public.

North Carolina

North Carolina Health Reform Overall Advisory Group
September 2011

The North Carolina Departments of Insurance and Health and Human Services, in cooperation with the North Carolina Institute of Medicine, have formed the Health Reform Overall Advisory Group to coordinate the work of eight health reform workgroups that have been created to help with health care reform implementation and to address any cross-cutting issues that may arise. The eight health reform workgroups over which the Advisory Group presides, include the Prevention, Safety Net, Health Professional Workforce, Health Insurance Exchange and Insurance Oversight, Medicaid, New Models of Care, Quality, and Fraud and Abuse Workgroups. 


The Advisory Group is co-chaired by Secretary Cansler of the Department of Health and Human Services and Commissioner Goodwin of the Department of Insurance, and includes representatives from the General Assembly, state agencies, insurance companies, health care organizations, and state colleges and universities. The Advisory Group released an Interim Report on Health Reform which provides an overview of the health care reform provisions being considered by each workgroup and the progress to date, and is now working on a final report.  The report provides an overview of the ACA as well as plans for implementation of a Basic Health Plan for individuals who make too much income to qualify for Medicaid.  While the Commissioner of Insurance is tasked with determining which state insurance benefit mandates will be incorporated into the essential health benefits, the plan is contingent on additional guidance from the Federal Department of Health and Human Services. 

The Overall Advisory Group met on March 14th where it reviewed and made comments on drafts of the following chapters of the final Health Reform report: Health Professional Workforce, Prevention, New Models of Care, and Fraud and Abuse. The Health Professional Workforce is concerned over the Governor’s executive Order 85 that merges the Division of Public Health (DPH) and the Office of Rural Health and Community Care (ORHCC). The Prevention workgroup discussed the recommendation for the availability of over-the-counter nicotine replacement therapies (NRT). The New Models of Care workgroup recommended that the chapter make clearer that the consumers should also be actively involved in the design and implementation of new models of care.

North Dakota

North Dakota Health Care Reform Review Committee
September 2011

The Committee is a 2011-2012 interim committee made up of members of both houses of the Legislature. The Committee will receive regular updates from the Insurance Commissioner with respect to steps taken to ensure health insurer procedures are in compliance with the PPACA. The Commissioner will also update the Committee on proposed legislation for consideration at a special legislative session if the Commissioner is required by federal law to implement any requirement before January 1st, 2013. The Committee will also receive reports from the Commissioner on implementation of an exchange. 

At a July 2011 meeting, the Committee was updated on the status of state implementation of the PPACA and the state of federal Health and Human Services recently released guidelines on the PPACA. They also discussed the National Association of Insurance Commissioners American Health Benefit Exchange Model Act. The Committee's next meeting will be to discuss the impact of the Affordable Care Act with a focus on reviewing proposed legislation creating a state health care exchange.

 

Ohio

Ohio Health Benefits Exchange Task Force
September 2011

The Health Benefit Exchange Task Force (Task Force) was created in October 2010 to consider issues and provide guidance to the state government on the key decision points and topics related to the implementation of a health insurance exchange. Co-chaired by the Chief Policy Officer at the Ohio Department of Insurance and the Medicaid Director, the Task Force includes consumers, employers, health care providers, insurance carriers, insurance agents, and state officials. The Task force held four meetings throughout Fall 2010. At its October 28th, 2010 meeting, they decided that Ohio should establish its own exchange rather than having the federal government establish and operate an exchange in Ohio. The Task Force made this and other recommendations to Governor-elect Kasich (R) on December 27th, 2010 in a transition document entitled "Transition of Health Exchange Planning to the New Administration." The Task Force is no longer meeting - its future under Governor Kasich's administration is unknown.



Oklahoma

Oklahoma Health Insurance Exchange Workgroup
April 2012

The Oklahoma Health Insurance Exchange (OHX) is an Oklahoma based, public-private partnership created to make health insurance more readily available to individuals without other coverage and to small employers. The Insurance Department, Health Care Authority, and Department of Mental Health and Substance Abuse Services established the state-administered OHX and created a Workgroup to advance the process. The Workgroup is comprised of representatives from various stakeholder groups. A series of meetings were to be held across the state to discuss the necessary characteristics and functions of an exchange in Oklahoma, however stakeholder and workgroup meetings were cancelled.


Oregon

Oregon Health Policy Board
April 2012

The Oregon Legislature created the Health Policy Board in 2009 and charged it with creating a comprehensive health reform plan for the state. The Board made recommendations to the Oregon Health Authority, the main agency implementing the PPACA, in its blueprint for health care reform and also made recommendations for the Exchange, which were presented to the Legislature during the 2011 session. The Board holds regularly scheduled meetings, generally on the second Tuesday of the month.  The April 10th meeting included an update from the Essential Health Benefits workgroup regarding their ongoing work.  One of the issues the workgroup will explore is coverage of habilitation services, as they are not currently covered by potential benchmark insurance plans.

Oregon Health Insurance Exchange Board
April 2012

The Oregon Health Authority established the Oregon Insurance Exchange Board (Exchange Board) in 2011.  The Oregon Health Authority is developing a detailed plan for Oregon's health insurance exchange, based on the Oregon Health Policy Board's recommendations.  The Consumer Advisory Committee met on April 6th, discussing public comment on priorities for the exchange and again on April 12th, where they received status reports from the Oregon Health Policy Board subgroups, including the Essential Health Benefits workgroup.

Oregon Essential Health Benefits Workgroup
April 2012

The Health Authority established the Essential Health Benefits (EHB) workgroup, jointly chartered by the Oregon Health Insurance Exchange (ORHIX) Board and the Oregon Health Policy Board (OHPB). Another step in beginning to implement the Health Insurance Exchange, the EHB workgroup is tasked with developing recommendations on the essential health benefits package benchmark plan for Oregon’s individual and small group market.

The EHB workgroup will review essential health benefits and define them by using a benchmark approach reflecting a "typical employer plan." The United States Department of Health and Human Services (HHS) indicated that states must base their choice on one of the following benchmark health insurance plans: (1) the largest plan by enrollment in any of the three largest small group products in Oregon’s small group market; (2) any of the three largest state employee health plans by enrollment; (3) any of the three largest federal employee health plan options by enrollment; or (4) the largest insured commercial non-Medicaid HMO plan operating in Oregon.

The Governor will appoint the members of the EHB workgroup. The first workgroup date has not been announced.


Pennsylvania

Pennsylvania Department of Insurance Exchange Forum
September 2011

The Pennsylvania Insurance Department held three forums in August to gather public input on health insurance exchanges. The Department is interested in input from all parties impacted by the formation of health insurance exchanges. Key areas of focus include: 1) The establishment - state based or federal government; 2) The oversight - how and who should operate and govern, and; 3) The functionality - what functions should it provide and to whom? The forums were held on August 9th in Pittsburgh, August 11th in Philadelphia, and August 23rd in Harrisburg. A video of the forums available online. View PA Forums

Pennsylvania Commonwealth Health Care Reform Implementation Committee
September 2011

The Commonwealth Health Care Reform Implementation Committee and the Commonwealth Health Care Reform Implementation Advisory Committee were created by Executive Order of Governor Edward Rendell (D) on May 19th, 2010. The Advisory Committee and Subcommittees have been meeting regarding federal grant initiatives, implementation of insurance exchanges, as well as access and enrollment principles. The Advisory Committee is made up of legislators, and members of both the private and public health care sector. The Committee has not met since January 2011. As the Committee was formed under former Governor Rendell, it is not expected to have a role with PPACA implementation in the future.



Rhode Island

Rhode Island Healthcare Reform Commission
April 2012

Governor Lincoln Chafee (I) established the Healthcare Reform Commission by executive order on January 13th, 2011 with the purpose to help implement the PPACA, although it is not limited to that role. Lt. Governor Elizabeth Roberts will chair both the Commission and the Executive Committee of the Commission. While the Executive Committee will be responsible for implementing the Affordable Care Act, the Commission will provide input. The Executive Committee is comprised of the Lieutenant Governor, the Director of the Department of Administration, the Health Insurance Commissioner, the Secretary of the Office of Health and Human Services, and the Director of the Governor's Policy Office. Members of the Commission were appointed by the governor and were drawn from the medical professions, public health fields, business, and other fields. Directors of state agencies may also be asked to serve on the Commission as circumstances dictate. The Full Commission met on April 5th to receive an update on federal essential benefits guidance and to discuss essential benefits generally.  The Health Insurance Exchange Work Group meets on April 16th to receive an introduction to essential health benefits and an overview of the process moving forward.  The next meeting is May 11th.


South Carolina

South Carolina Exchange Planning Committee
September 2011

The Exchange Planning Committee, established by Governor Nikki Haley (R) under Executive Order 2011-09, operates as an advisory group to assist with necessary research as determined by the Insurance Commissioner and to provide recommendations on the exchange planning process. The Committee is conducting a thorough review and analysis of current and new data on the operation of exchanges, developing an in-depth study and review of alternative approaches to the exchange, and preparing a report to submit to the Governor by October 28th. This report will set forth the Committee’s recommendations regarding whether the State should establish an exchange. The Committee met on June 30th, 2011 - the next meeting has not been announced.


South Dakota

South Dakota Health Insurance Exchange Task Force
September 2011

The Health Insurance Exchange Task Force, chaired by Lieutenant Governor Matt Michels, formulated a strategy by which the state will offer health insurance through an Exchange. The recommendations of the Task Force were sent to Governor Daugaard and considered during the 2011 Legislative session. The Task Force was divided into three subcommittees: 1) Operations and Finance; 2) Outreach and Communication, and; 3) Insurance Plan and Market Organization. While the PPACA is unpopular in South Dakota, the Administration views it as prudent to proceed with the implementation. The Task Force and subcommittees met on August 16th, 2011 and produced recommendations that may be viewed online. View SD Recommendations


Tennessee

Tennessee Insurance Exchange Planning Initiative
September 2011

The Tennessee Insurance Exchange Planning Initiative is tasked with investigating whether the state should operate a state-level exchange and, if so, how it might be structured. The Insurance Exchange Planning Initiative has formed two Technical Advisory Groups (TAGs) to help with the insurance exchange planning process. The Actuarial/Underwriting TAG will focus on analytical issues relating to risk pool structure, adverse selection, risk adjustment, and rating areas. The Agent/Broker TAG will focus on operational and market questions, ultimately providing a detailed inventory of options for state decision-makers in the form of discussion papers for public review and comment. Additional TAGs are planned in the future. A Provider and Advocate Roundtable has also been formed to solicit the input of health care providers and advocates regarding the Exchange. A formal advisory group of health care providers will not be formed until the State receives additional federal guidance. The next meeting of the TAGs and the Roundtable have not been announced.


Texas

Check back for future activity updates.


Utah

Utah Health System Reform Task Force
September 2011

The Health System Reform Task Force,  co-chaired by Representative David Clark (R) and Senator Wayne Niederhauser (R), met and received updates on the Utah Health Exchange. An update on the launch of the Exchange to all small employers and the limited launch to large employers was recently provided to the Task Force. The Task Force also received reports on the coordination of the response to federal health care reform and the implementation of exchanges within that reform. Reports have also been provided to the Task Force on the high risk pool for persons with pre-existing conditions and tax consequences of federal health care reform. The next meeting of the Task Force has not been announced.


Vermont

Vermont Blueprint for Health
April 2012

The Agency for Human Services adopted rules creating the Vermont Blueprint for Health (Blueprint) program. The adopted rules implement changes authorized by Act 128, that authorizes the Blueprint to move from a pilot program to a broadly implemented statewide program. The Blueprint is Vermont's program for implementing a system of health care for patients, improving the health of the overall population, and improving control over health care costs by promoting health maintenance, prevention, and care coordination and management.

The adopted rules concern governance of the Blueprint for Health, advisory groups, medical home requirements, application, eligibility/enrollment and certification, reimbursement, community health teams, application and designation requirements, and health insurer requirements.

The Payment Implementation Group will meet on April 4th; the Expansion Design and Evaluation Group will meet on April 11th and; the Executive Committee will meet on May 16th.

Vermont Green Mountain Care Board
April 2012

The Green Mountain Care Board (Board) was created by the Vermont Legislature to oversee the design of Green Mountain Care, the state's single-payer health care system. The Board's implementation of the single-payer health care system will be coordinated with the PPACA, but will be more comprehensive. The Board's health care priorities include: overseeing a new health care payment and delivery system; reviewing and approving BISHCA recommendations for new insurance rates, hospital budgets and major capital expenditures by health care providers; approving benefit plans for Vermont's health benefits exchange; developing programs to assess and enhance quality and safety in the health care system; and approving a plan for an information technology system.
With regard to Green Mountain Care, the Board will: define the Green Mountain Care benefit package; recommend a three-year Green Mountain care budget that will be Vermont's universal health care budget; and annually report to the Legislature on progress on achieving Green Mountain Care goals. 


At a March 29th meeting, the Board received a briefing on essential benefits, followed by an April 3rd meeting where the Board heard testimony from the Director of VA Mental Health Integration on the Patient Aligned Care Team (PACT) model with explanations of where various types of care fit into the VA’s plan. The VA model provides an example of integrating primary care with specialized care and community care.  The April 12th meeting featured discussion of the Public Service Board.  The Board will have additional meetings on April 17th and 19th.



Virginia

Virginia Health Care Reform Initiative Advisory Council
April 2012

The Virginia Health Care Reform Initiative Advisory Council was established to provide recommendations to the Governor on a comprehensive strategy for implementing health care reform in Virginia. The Advisory Council reviewed everything from reforming Medicaid and the delivery and payment system, to improving electronic health records and established task forces in six key areas: 1) Medicaid reform (including the need for coordination for care for all participants); 2) service delivery (including management of chronic diseases); 3) health insurance regulations (looking at statutory changes needed to implement the national health care reform legislation mandates); 4) workforce (examining capacity and education issues); 5) health information technology, and; 6) purchasers' perspective (assessing employers' interests as health insurance purchasers). The Council released its report to the Governor on December 20th, 2010. The next Advisory Council meeting has not yet been scheduled.


Washington

Washington Health Benefit Exchange Development Board
April 2012

The Health Benefit Exchange Development Board (Exchange Board or Board) was established to: 1) coordinate with the Administrator of the State Health Care Authority to successfully complete implementation of planning and establishment grants received by the Authority pursuant to the federal Affordable Care Act; and 2) develop a business plan and timeline for implementing a state-administered health benefits exchange. The Exchange Board is composed of seven people, appointed by the Governor and the Washington State Insurance Commissioner, all with expertise in the state health care system and private and public health care coverage. The Administrator of the Washington State Health Care Authority serves as the Chair of the Board. The Board has the authority to make recommendations and the Administrator may make rules based upon those recommendations.


At their April meeting, the Board discussed the Federal Basic Health Option for services to individuals not eligible for Medicaid.  Additionally, the Board received an update on IT development for the exchange.  The Board is scheduled to meet again on May 16th. 


West Virginia

Check back for future activity updates.


Wisconsin

Wisconsin Special Committee on Health Reform Implementation
April 2012

The Special Committee on Health Reform Implementation, co-chaired by Representative Pat Strachota (R) and Senator Alberta Darling (R), has been meeting to discuss the implementation of federal health care reform. The Special Committee has discussed organizational matters and has received presentations from various policy groups. Formed as a interim study committee for the 2010-2012 period, the Special Committee is expected to present a report to the Legislature at the end of this time. The next Committee meeting has not been announced.


Wisconsin has received several grants associated with the PPACA, including: (1) a $637,114 grant for the consumer assistance program; (2) a $999,873 grant for health insurance exchange planning; (3) a $1,000,000 grant for health insurance rate review; and (4) a $37,757,266 Early Innovator Grant for information technology infrastructure for the exchange. The Department of Health Services developed a prototype for an exchange; the Office of Free Market Health Care conducted a survey on the design of an exchange; and the Office of Free Market Health Care released a report on the impact of the PPACA on the individual and small group markets.

Governor Walker (R) directed the Department of Health Services to notify the federal government that Wisconsin will turn down funding from the Early Innovator Grant program and discontinue any development on a health exchange. Governor Walked (R) also signed Executive Order 57 on January 18th, 2012 to dissolve the Office of Free Market Health Care.


Wyoming

Health Insurance Exchange Steering Committee
April 2012

The Insurance Department received an $800,000 grant for the following activities:
  1. Form a Task Force to determine if Wyoming will pursue a state-based exchange, a regional exchange, or allow the Federal government to operate an exchange;
  2. Develop recommended actions necessary to establish a functioning exchange; and
  3. Propose legislative action if the governor and Task Force recommend that Wyoming participate in the operation of the state’s insurance exchange, via a partnership with the University of Wyoming.

The Health Insurance Exchange Steering Committee released a preliminary recommendation that Wyoming should create its own insurance exchange and not participate in a regional or federal exchange. The Steering Committee also recommended that Wyoming collaborate with other states in some aspects of the exchange, such as information technology.  The Steering Committee met on March 28th to discuss the 2012 legislative activity, planning grant, Steering Committee work plan, and federal partnership models.