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 | January/ February |
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 | January/ February |
Jon Kingsdale/ Patrick Holland |
Completed | Meeting materials |
| 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 between 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 |