Further defined several aspects of the state-based health insurance exchange, including:
Operating Model: Allows the MHBE to set requirements for qualified health plans (QHP) that go beyond those defined by the ACA.
Market Rules: Requires carriers with over $20M in premium revenue in the small group, and $10M in individual, to participate inside the state-based exchange; requires any carrier offering a catastrophic plan to participate inside the state-based exchange.
SHOP: Establishes a distinct Small Business Health Options Program (SHOP); limits enrollment to employers with less than 50 employees (through 2016); allows for employee choice as defined by ACA as well as current market model.
Navigator Programs: Creates separate programs for SHOP/individual; allows brokers to continue to sell plans in the state-based exchange with authorization but without becoming navigators; requires certification for navigators and authorization for navigator entities; defines oversight relationship between the MHBE, MIA and DHMH to ensure all programs are addressed and coordinated.
Financing: Creates a joint legislative/executive committee to conduct a further study of specific financing mechanisms to determine the most appropriate and effective option; report is due to General Assembly on 12/1/12; ultimate decision on financing to be determined during the 2013 General Assembly.
Essential Health Benefits (EHBs): Defines Health Care Reform Coordinating Council (HCRCC) as body to determine benchmark plan through public stakeholder process.
Risk Adjustment and Reinsurance: Requires the MHBE to “strongly consider” using the federal risk adjustment model initially and then to conduct a study to determine whether a different model would be more effective.
Fraud, Waste & Abuse: Requires the MHBE to establish and report to the General Assembly its plan for a fraud, waste and abuse prevention program.
Dental & Vision: Allows the state-based exchange to offer optional dental and vision plans; specifically states that it cannot offer anything outside of medical, dental and vision
The Maryland Health Progress Act (SB 274/HB 228), signed into law by Gov. Martin O’Malley in May 2013 represents the last step in the three-year effort to use the tools of the Affordable Care Act to enhance access to quality and affordable health care for residents and small employers in the state. The Health Progress Act enacts the remaining policies necessary for the MHBE to expand Medicaid eligibility and, together with HB 361, which conforms state law to the federal consumer protections and insurance market reforms going into effect next year, the Maryland Health Progress Act of 2013 ensures that Marylanders will reap the full benefits of health care reform and effective implementation of the Affordable Care Act.
In brief, the Health Progress Act of 2013 addresses:
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