healthexchange

Serving as the health care reform lead for the State of Indiana, SVC has developed a deep understanding of the regulatory and operational requirements in all Marketplace models for states and issuers.  SVC led the research and study of the Affordable Care Act (ACA) from its inception for Indiana. This study consisted of comparing the many facets of the Marketplace options. This included identifying the ACA regulations that would impact state policy and existing statutory authority, such as the Health Care Exchanges or Marketplaces. As part of the analysis, SVC worked with the State Medicaid agency and Indiana Department of Insurance to develop key tools and programs to aid in crafting the best approach for the State of Indiana in meeting the ACA requirements. SVC also worked with the Nebraska Department of Insurance to develop tools to estimate enrollment in a State Marketplace and to complete a Rate Review Grant proposal.

Some of SVC's efforts included:

• Tool for identifying and comparing State plan options to meet the Essential Health Benefit (EHB) requirements;
• Assessment of the marketplace for both the private and public health care sectors to identify the populations and existing regulations the ACA may impact; and
• Consumer Assistance program to protect individuals from receiving Marketplace information that is not compliant with the State's private and public health care options.

In defining the Consumer Assistance program, SVC fully-implemented the program by assisting Indiana state agencies in addressing policy, technical and operational requirements. While identifying the policy and operational impacts of the state and new federal regulations to properly implement the program, SVC helped the State of Indiana create a platform that protected Indiana's insurance consumers from potential fraud. In recognizing the impact on both the Medicaid agency and the Indiana Department of Insurance, SVC brought both agencies together along with the input of internal and external stakeholders to develop the program. SVC began collecting data of existing consumer programs and interviewing key contacts to implement a program tool to identify key decision points with possible state options. In utilizing the tool, SVC worked jointly with the agencies to develop key program standards that required certification of individuals or organizations that assist those applying for Marketplace or government coverage programs.

In collaborating the regulatory needs, policy decisions and operational standards of both agencies, SVC was able to aid in the development of a program the agencies could jointly manage. In this joint effort, SVC led initiatives to draft and pass State legislation, working with key stakeholders and legislators. Additionally, SVC headed the following:

• Identified funding for the program;
• Drafted the Memorandum of Understanding between the two State agencies:
• Drafted the operational plan and program's rules and regulations;
• Developed an extensive training manual to provide a comprehensive explanation of ACA policies, the implications for the federal Marketplaces in Indiana and the Consumer Assistance program; and
• Utilized the manual developed to generate training presentations for a broader audience into a format that made the information accessible for the general public.

SVC also created other tools that could be used by stakeholders and state employees in implementing the Consumer Assistance program.

In addition to the development of customized state based programs, SVC is also proficient in analyzing complex insurance regulations and meeting the ACA requirements across the markets for private or public sectors. SVC has studied the complexities of options for Alternative Benefit Plans (ABP) required for Medicaid Expansion as related to commercial market standards and is experienced in ABP analysis, design, development and completion of all required CMS ABP templates.  SVC continues to review state and federal requirements around offering different plan options for health insurance coverage to consumers.

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