Advisory Working Groups
A top of priority of the HBX is building industry partnerships and engaging consumer and community groups in developing and implementing the insurance exchange. The executive director of the HBX firmly believes that to build a successful health insurance exchange where residents, families and small businesses can choose quality affordable health plans, it must be built from the ground up and involve everyone.
The resources of sister government agencies, health care leaders, community advocates, small business owners and industry professionals must be leveraged in working together to establish a health insurance exchange that meets the needs of consumers and businesses.
The process for involving stakeholders is through the Advisory Working Groups. These working groups will be chaired by a board member and vice chaired by a member of the HBX Standing Advisory Board. The groups will be given topic specific issues to address within set time-frame. Stakeholders will be asked to serve as members on the working groups and share their professional expertise.
The new Advisory Working Groups will be community based and will perform their work between January and March 2013.
DC HBX Working Groups
|Working Group||Description||Chair||Vice-Chair||Timeframe||Facilitator||Status||Reports & Materials|
|Essential Health Benefits||Make recommendations on outstanding policy questions related to the District's EHB benchmark plan including habilitative care definition, mental health parity, prescription drug formulary, and EHB benefit substitution.||Saul Levin||Kevin Dougherty||
|Jon Kingsdale||Completed||Meeting materials|
|Network Adequacy||Review existing network adequacy requirements and recommend any new standards/changes if necessary.||Diane Lewis||Stephen Jefferson||February||David Helms and Alice Burton||Completed||Meeting materials|
|Premium Billing and Collections||Recommend whether the Exchange should collect premiums for individual coverage.||Henry Aaron||Chris Gardiner||
|Plan Offerings and Benefit Standardization||Make recommendations on whether to specify the number of policy variations offered through the Exchange (within metal levels), whether to require a standardized QHP benefit design which includes cost sharing, and whether to allow or limit benefits not part of the EHB benchmark.||Kate Sullivan Hare||Claire McAndrew||February||Jon Kingsdale||Completed||Meeting materials|
|Employer and Employee Plan Choice||Recommend approach for small businesses (e.g. employee choice) for choosing plans, issuers, and contribution to coverage for workers; includes consideration of age rating.||Kevin Lucia||Billy McCartee||February||Jon Kingsdale||Completed||Meeting materials|
|QHP Issuer Certification Process||Recommend standards for certifying QHP issuers.||Kevin Lucia||Katherine Stocks||February||Mary Beth Senkewicz||Completed||Meeting materials|
|Financial Sustainability||Recommend revenue sources including assessments to ensure financial sustainability of the Exchange by 2015.||TBD||Jill Thorpe||March||Suzanne Peck, et al||Completed||Meeting materials|
|Quality||Examine quality ratings for health plans, necessary data collection by the Exchange, and consumer use of quality ratings for implementation after year 1.||TBD||Karen Johnson||March||David Helms||Completed||Meeting materials|
|Assister Grant Estimates||Recommend the necessary level of funding for the Exchange Assisters grant program to inform the Exchange on its request for federal funding.||Dave Chandra||TBD||February||Suzanne Peck||Completed|
|Eligibility, Enrollment & Churn||Make recommendations on outstanding policy questions related to eligibility and enrollment, as well as options for providing continuity of care for individuals churning beween commercial insurance in the Exchange and Medicaid.||Wayne Turnage||Don Blanchin||April/May||Jon Kingsdale||Completed||Meeting materials|
|Dental Plans||Recommend standards and benefit offerings for stand-alone dental plans offered in the exchange marketplace.||Leighton Ku||Katherine Stocks||March||Mary Beth Senkewicz||Completed||Meeting materials|
|Carrier IT||Develop business requirements for issuer's connectivity with the Exchange (data submissions, etc).||Leighton Ku||TBD||February/ Ongoing||Suzanne Peck||Completed|
|Broker IT||Develop business requirements for broker interactions and broker functionality for on-line enrollment and plan selection (also inclused standards for broker selection and participation).||Janet Trautwein||Billy McCartee||January/ Ongoing||Suzanne Peck||Completed|
|Assistors IT||Develop business requirements for assistor interactions and functionality for online enrollment and plan selection.||Kishan Putta||Henry Aaron||February/ Ongoing||Suzanne Peck||Completed|
|IT Policy||Review"off-the-shelf" on-line application/enrollment, identify policy questions that require modifications, and develop business requirements for modifications as necessary.||Leighton Ku||Dave Chandra||February/ Ongoing||Suzanne Peck||Completed|
In addition to the Advisory Working Groups, three (3) Advisory Boards will be established, Producer, Plan Management, and Consumer Assistance.