Arkansas Health Exchange Profile
Establishing the Exchange
On December 12, 2012, Governor Mike Beebe (D) informed federal officials that Arkansas would pursue a state-federal partnership health insurance exchange. A state opting for a partnership exchange can choose to operate plan management functions, consumer assistance functions, or both. A state can also elect to perform Medicaid and Children’s Health Insurance Program (CHIP) eligibility determinations or use federal government services. While the Governor acknowledged in November 2012, the possibility of pursing a state-run exchange if the Arkansas Legislature enacted exchange authorizing legislation, the state continues to plan for a partnership exchange.
Arkansas has moved quickly to define its role in a partnership exchange, focusing on maintaining flexibility and control over insurance plan selection, rating, monitoring and consumer assistance functions including, outreach, education, and an In-person Assister program. The Department released a comprehensive framework for the Exchange, noting primary sponsorship and decision-making rests with the Insurance Commissioner. A Steering Committee was also created to authorize resources and provide oversight. The Committee meets monthly and members include senior management from the Insurance Department, the Department of Human Services, Arkansas Health Agency Leaders, Advisory Committee Co-Chairs, the Department of Finance and Administration, the Legislature, and the Governor’s office.
Contracting with Plans: In early 2012, the Insurance Department issued a Request for Proposals (RFPs) for subcontractors to assist with the development of Exchange requirements related to qualified health plan certification. The state has since created a Plan Management Advisory Committee comprised of dozens of stakeholders representing hospitals, insurers, businesses, and consumers. The Committee meets bi-monthly and focuses on the definition and delivery of Qualified Health Plan guidelines. Recommendations from the Advisory Committee are forwarded for approval to the Steering Committee, and then sent to the Insurance Commissioner for approval. In September 2012, the Commissioner approved recommendations that Arkansas not require network adequacy standards that exceed the federal requirements in the first year, that carriers not be required to offer qualified health plans statewide, and that the state may limit the number of plans or benefit designs offered by a carrier.
Consumer Assistance and Outreach: Various consumer assistance and outreach activities are facilitated by the Arkansas Insurance Department and through subcontractors. In early 2012, the Insurance Department began planning for a Navigator program and awarded multiple RFPs to subcontractors to assist with development. Soon thereafter however, the Center for Consumer Information and Insurance Oversight clarified that in a partnership exchange, the Navigator program will be run by the federal government, but all states have the option to develop an In-Person Assister Program. The In-Person Assister program functions similarly to a Navigator program, but can use federal Exchange Establishment grants for development and operation. Over the past few months, Arkansas has focused significant effort on developing an In-Person Assister Program and eventually, hopes to brand both the Navigator and In-Person Assister programs as one, so that to consumers they appear the same.
The state has created a Consumer Assistance Advisory Committee comprised of dozens of stakeholders representing consumers, hospitals, and community organizations. The Committee meets bi-monthly and focuses on developing In-Person Assister (IPA) guidelines, outreach efforts, and consumer complaint resolution. Since May 2012, the Advisory Committee has issued numerous recommendations regarding IPAs including that brokers and producers be allowed to serve as IPAs, that IPAs complete a state training for certification with certain defined competencies, and that the state pay IPA entities using a combination of a contract payment and performance-based payment. Recommendations have been forwarded to the Steering Committee for review.
Coordination with Medicaid: Arkansas plans to interface their Medicaid program with the federally-facilitated exchange. The Department of Human Services (DHS), which includes the state’s Medicaid agency and multiple other agencies, determined the state will use the “Access Arkansas” portal as an Exchange interface. Arkansas received approval from the Centers for Medicare and Medicaid Services (CMS) for enhanced funding to upgrade its Medicaid eligibility and enrollment systems.
Essential Health Benefits (EHB): The Affordable Care Act (ACA) requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. States must decide whether to benchmark their EHB plan to one of ten plans operating in the state or default to the largest small-group plan in the state. The Arkansas Insurance Department accepted Rule 103, which granted EHB-decision-making authority to the Insurance Commissioner. Based on analyses and stakeholder feedback, the Arkansas Exchange sent preliminary EHB recommendations to the Commissioner for review which were accepted. Preliminary recommendations included the small group plan Arkansas Blue Cross Blue Shield Health Advantage Point of Service Plan as the benchmark. Also, the state chose QualChoice Federal Plan Mental Health and Substance Abuse Benefits to meet the federal mental health parity requirement, the Arkansas Children’s Health Insurance Plan (CHIP) for pediatric dental services, and the Arkansas Blue Cross Blue Shield Federal Pediatric Vision Plan for pediatric vision coverage.
The Arkansas Insurance Department received a federal Exchange Planning grant of almost $1 million in 2010. In September 2011, Governor Beebe contemplated applying for a Level One Establishment grant but declined after hearing lawmakers’ objections. A few months later however, the state submitted an application for $7.6 million in federal funding to implement the partnership exchange. In February 2012, the grant was awarded and Arkansas plans to use the funds to design and implement IT systems to connect Arkansas Medicaid and state-run exchange functions to the federally-operated eligibility and enrollment portal, implement systems to support state-operated consumer assistance functions, and develop plan management functions of the Exchange. In September 2012, Arkansas received a second Level One Establishment grant of $18.6 million to work in partnership with the federal government and other state stakeholders to implement plan management and consumer assistance components of the Exchange.
On January 3, 2013, Arkansas received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a state-federal partnership exchange. Final approval is contingent upon the state demonstrating its ability to perform all required Exchange activities on time, complying with future guidance and regulations, and maintaining a federal funding source through plan year 2014. The state must also sign a memorandum of understanding with CMS that defines roles and responsibilities for Exchange plan management and consumer assistance, outreach, and education operations by February 15, 2013.
Additional information about Arkansas’ Health Benefit Exchange planning can be found at:http://www.hbe.arkansas.gov/