Common use of SHOP Clause in Contracts

SHOP. HBEPD has facilitated numerous stakeholder forums and targeted workgroups aimed at fostering discussion and gathering information from the individuals and groups who will be most impacted by the development of the Exchange. Based on expressed concern that employers would drop coverage after Exchanges are introduced, our Exchange Planning Policy Consultant from the Arkansas Center for Health Improvement (ACHI) prepared a policy brief in August, 2011, titled, “Will Employers Drop, Keep, or Add Health Insurance in 2014?” (Link to full article: xxxx://xxx.xxxx.xxx/HCR%20Docs/110808%20ISSUE%20BRIEF%20EMPLOYER%20RESPONSE.pdf). It reviewed factors that suggest employers will drop, keep, or add coverage and reviewed five national studies (Mercer, McKinsey, Congressional Budget Office, RAND, and Urban Institute). The report concluded that the overall availability of employer-sponsored insurance is not likely to change much after 2014. Our Exchange Planning Steering Committee recommended a targeted outreach education effort in the fall of 2011 to small businesses. This was needed to counteract negative messages aimed at business owners. The HBEPD entered into a contract with ACHI/UAMS to design an education program targeting small business owners. The design work is complete and catchy, positive radio and print media ads were to be launched in October 2011 using Exchange Planning funds. However, the ads were delayed due to Legislative objection. We are now planning to run the ads in the fall of 2012 using already awarded Level One funds. Since hiring the Plan Management Specialist, HBEPD has been actively engaged with CCIIO and CMS to ensure a successful implementation of the SHOP program with the federal government. Currently, Arkansas is waiting for additional regulations and answers to questions from CCIIO related to what roles and responsibilities Partnership states will assume within the SHOP program. It is our understanding that the individual and SHOP markets will be separate as part of the FFE Partnership Model. We await guidance on Agent/Broker training and FFE “certification” requirements for the SHOP. PROPOSAL TO MEET PROGRAM REQUIREMENTS Building on the work of the last almost two years and using funds provided by our Planning Grant (awarded 9/30/10 with Administrative Supplement awarded 3/8/12) and Level One Grant (awarded 2/22/12), the HBEPD is making steady progress toward implementing the FFE-Partnership model for Arkansas. Some activities (primarily early research) have been completed and are providing state-specific information. These activities are discussed in detail in the previous section of this document. Other activities such as re-working of our web page and many outreach and awareness activities are just getting underway. Delay is related primarily to delayed State Legislative approval for spending the Level One Grant funds. Arkansas chose to explore implementation of the FFE-Partnership model because it allows local development and oversight of the Exchange activities that most directly interact with Arkansans and the insurance carriers who do business in our state. From the onset of our planning efforts, we devoted much of our energy and resources to interaction with a wide range of stakeholders and consumer groups. As we continue to nurture and grow those relationships, HBEPD feels that we are well positioned to represent and assist Arkansans as they negotiate the new Health Insurance Exchange landscape. Arkansas Insurance Department (AID) has a long, successful history of working with and regulating our insurance issuers. We are building on these relationships and regulatory structure as we define our EHB benchmark and the criteria for QHP certification that are compliant with state and federal regulations and in the best interest of our consumers. Throughout all our efforts we are working closely with our sister state agencies, our CCIIO project officer and others at CCIIO, CMS and DHHS to assure adequate, timely collaboration with our Federal partners. As we have learned more about the challenges Arkansas faces and the requirements of the FFE Partnership, we have identified the need for additional resources to increase the HBEPD staff, continue utilizing valued consultants, engage new consultants as needed for specialized research, expand targeted outreach activities and develop the infrastructure needed to create, operate, monitor, and improve a statewide In Person Assister (IPA) program and Arkansas QHP certification and monitoring program. Through this Level One Grant application, Arkansas is seeking funds for identified needs to continue implementation activities in two specific areas of the FFE Partnership: 1) Consumer and Stakeholder Engagement and Support, and 2) Plan Management. Working together to develop the FFE Partnership Model for Arkansans, we are confident that DHHS and Arkansas can and will develop an efficient, user‐friendly health benefits exchange partnership that meets our mutual goal of increasing health insurance coverage of low and moderate income Arkansans by making quality, affordable plans easily accessible. The specific activities we plan to undertake with the requested funding are described in the following sections. Current Exchange Pathway As indicated throughout this document, Arkansas is taking deliberate, planned steps to implement the FFE Partnership Model by January 1, 2014 with Open Enrollment October 1, 2013. There are no current plans for a State- based Exchange. However, as more well defined regulations and requirements are provided from CCIIO, we will continuously evaluate this stance and assure that the State’s leadership is apprised of any DHHS guidance that could trigger reconsideration of this position. We acknowledge that DHHS views the development of an FFE Partnership as a logical stepping stone to evolve into a State-based Exchange at some future date.

SHOP. HBEPD AHCD has facilitated numerous stakeholder forums and targeted workgroups aimed at fostering discussion and gathering information from the individuals and groups who will be most impacted by the development of the ExchangeMarketplace. Based on expressed concern that employers would drop coverage after Exchanges Marketplaces are introduced, our Exchange Planning Policy Consultant from the Arkansas Center for Health Improvement (ACHI) ACHI prepared a policy brief in August, 2011, titled, “Will Employers Drop, Keep, or Add Health Insurance in 2014?” (Link to full article: xxxx://xxx.xxxx.xxx/HCR%20Docs/110808%20ISSUE%20BRIEF%20EMPLOYER%20RESPONSE.pdf). It 2014 xxxx://xxx.xxxx.xxx/HCR%20Docs/110808%20ISSUE%20BRIEF%20EMPLOYER%20RESPONSE.pdf.The brief reviewed factors that suggest employers will drop, keep, or add coverage and reviewed five national studies (Mercer, McKinsey, Congressional Budget Office, RAND, and Urban Institute). The report concluded that the overall availability of employer-sponsored insurance is not likely to change much after 2014. Our Exchange Planning Steering Committee recommended a targeted outreach education effort in the fall of 2011 to small businesses. This was needed to counteract negative messages aimed at business owners. The HBEPD entered into a contract with ACHI/UAMS to design an education program targeting small business owners. The design work is complete and catchy, positive radio and print media ads were to be launched in October 2011 using Exchange Planning funds. However, the ads were delayed due to Legislative objection. We are now planning to run the ads in the fall of 2012 using already awarded Level One funds. Since hiring the Plan Management Specialist, HBEPD AHCD has been actively engaged with CCIIO and CMS to ensure a successful implementation of the SHOP program with the federal government. Currently, Arkansas is waiting for additional regulations and answers to questions from CCIIO related to what roles and responsibilities Partnership states will assume within the SHOP program. It is our understanding that the The individual and SHOP markets will be separate as part of the FFE Partnership ModelSPM model. We await guidance As the result of federal changes, employers in 2014 will choose one plan for their employees as they do now. AHCD has contracted with the University of Arkansas at Little Rock Arkansas Small Business and Technology Development Center (ASBTDC) for outreach to the small business community, with emphasis on Agent/Broker training SHOP. ASBTDC will work closely with the Small Business Administration regional office and FFE “certification” requirements for the SHOPstate and local xxxxxxxx of commerce. PROPOSAL TO MEET PROGRAM REQUIREMENTS Building on the work of the last almost two two-plus years and using funds provided funded by our Planning Grant (awarded 9/30/10 September 2010 with Administrative Supplement awarded 3/8/12) March 2012), Level One A grant (awarded February 2012), Level One B grant (awarded September 2012), and Level One Grant C grant (awarded 2/22/12April 2013), the HBEPD ACHD is making systematic, steady progress toward implementing the FFE-State Partnership Marketplace (SPM) model for Arkansas. Some activities (primarily early research) have been completed Early and are providing stateon-specific information. These activities are discussed in detail in going research coupled with guidance from CMS and our CCIIO state officer has supported our efforts as well as helped us plan for the previous section of this document. Other activities such as re-working of our web page and many outreach and awareness activities are just getting underway. Delay is related primarily to delayed State Legislative approval for spending the Level One Grant fundsfuture. Arkansas chose to explore implementation of the FFE-Partnership SPM model because it allows local development and oversight of the Exchange activities functions that most directly interact with Arkansans Arkansans, and the insurance carriers issuers and producers who do business in our state. From the onset of our planning efforts, we devoted much of our energy and resources to interaction with a wide wide-range of stakeholders and consumer groups. As we continue to nurture grow and grow learn from those relationships, HBEPD feels that we are well positioned AHCD has branded the Arkansas Health Connector as a vehicle to represent and assist Arkansans as they negotiate the new Health Insurance Exchange landscape. Arkansas Insurance Department (AID) has a long, successful history of working with and regulating our insurance issuers. We are building on these relationships and regulatory structure as we define our EHB benchmark and the criteria for QHP certification that are compliant with state and federal regulations and in the best interest of our consumers. Throughout all our efforts we are working closely with our sister state agencies, our CCIIO project officer and others at CCIIO, CMS and DHHS to assure adequate, timely collaboration with our Federal partnersMarketplace. As we have learned continue to learn more about the challenges Arkansas faces and the requirements of the FFE PartnershipSPM, we have identified the need for additional resources to increase the HBEPD staff, continue utilizing valued consultants, engage new consultants as needed for specialized research, expand targeted outreach activities and develop the infrastructure needed to create, operate, monitor, and improve a statewide In Person Assister (IPA) program and Arkansas QHP certification and monitoring programneeds. Through With this Level One Grant D grant application, Arkansas AHCD in summary is seeking funds for identified needs to continue for:  Additional staffing resources  The continued utilization of valued and necessary consultants  Extension of our statewide and deep outreach activities  Continuation of our far-reaching IPA services  Further development of our comprehensive Qualified Health Plan (QHP) certification, recertification and monitoring processes  Further study and implementation activities in two specific areas of the FFE Partnership: 1) Consumer and Stakeholder Engagement and Support, and 2) Plan Management. continuity of coverage plans Working together to develop the FFE Partnership Model for Arkansanstogether, we are confident that DHHS HHS and Arkansas can AID can, and will develop will, implement and improve an efficient, user‐friendly health benefits exchange partnership user-friendly SPM model that meets our mutual goal of increasing health insurance coverage of low for low- and moderate moderate-income Arkansans by making quality, affordable plans easily accessible. The specific activities we plan to undertake with the requested funding are described in the following sections. Current Exchange Pathway As indicated throughout this document, Arkansas is taking deliberate, planned steps to implement the FFE Partnership Model SPM model by January 1, 2014 with Open Enrollment open enrollment starting October 1, 2013. There Much thought and planning are taking place with an eye toward potentially establishing a State-Based Marketplace (SBM). Arkansas Act 1500 of 2013 allows the creation of an SBM no sooner than July 1, 2015, for the 2016 plan year at the earliest. However, there are no current plans for a State- based ExchangeSBM. HoweverThat decision will be up to the newly-appointed Board of Directors of the Arkansas Health Insurance Marketplace, as which was created by Act 1500. The board has yet to meet, but the clear intention of the legislation is to implement an SBM in Arkansas. As more well well-defined regulations and requirements are provided from CCIIO, we will continuously assist the Board in any way it sees fit as the members evaluate this stance and assure the best model for Arkansas. We will ensure that the Statestate’s leadership is apprised of any DHHS HHS guidance that could trigger reconsideration of this position. We acknowledge that DHHS HHS views the development of an FFE Partnership a SPM as a logical stepping stone to evolve into a State-based Exchange an SBM at some future date. We await direction from the Board. We all so understand that 1311 Establishment Grant funds may be requested for staffing the Arkansas Health Insurance Marketplace Board and subsequent SBM developmental needs.

SHOP. HBEPD has facilitated numerous stakeholder forums and targeted workgroups aimed at fostering discussion and gathering information from the individuals and groups who will be most impacted by the development of the Exchange. Based on expressed concern that employers would drop coverage after Exchanges are introduced, our Exchange Planning Policy Consultant from the Arkansas Center for Health Improvement (ACHI) prepared a policy brief in August, 2011, titled, “Will Employers Drop, Keep, or Add Health Insurance in 2014?” (Link to full article: xxxx://xxx.xxxx.xxx/HCR%20Docs/110808%20ISSUE%20BRIEF%20EMPLOYER%20RESPONSE.pdf). It reviewed factors that suggest employers will drop, keep, or add coverage and reviewed five national studies (Mercer, McKinsey, Congressional Budget Office, RAND, and Urban Institute). The report concluded that the overall availability of employer-sponsored insurance is not likely to change much after 2014. Our Exchange Planning Steering Committee recommended a targeted outreach education effort in the fall of 2011 to small businesses. This was needed to counteract negative messages aimed at business owners. The HBEPD entered into a contract with ACHI/UAMS to design an education program targeting small business owners. The design work is complete and catchy, positive radio and print media ads were to be launched in October 2011 using Exchange Planning funds. However, the ads were delayed due to Legislative legislative objection. We are now planning to run the ads in the fall as part of 2012 using already awarded Level One fundsPhase 1 of our outreach and education campaign. Since hiring the Plan Management Specialist, HBEPD has been actively engaged with CCIIO and CMS to ensure a successful implementation of the SHOP program with the federal government. Currently, Arkansas is waiting for additional regulations and answers to questions from CCIIO related to what roles and responsibilities Partnership states will assume within the SHOP program. It is our understanding that the individual and SHOP markets will be separate as part of the FFE State Partnership Exchange Model. We await guidance on Agent/Broker training and FFE “certification” requirements for the SHOP. PROPOSAL TO MEET PROGRAM REQUIREMENTS Building on the work of the last almost two two-plus years and using funds provided by our Planning Grant (awarded 9/30/10 with Administrative Supplement awarded 3/8/12), Level One A grant (awarded 2/22/12) and Level One Grant B grant (awarded 2/22/129/27/12), the HBEPD is making systematic, steady progress toward implementing the FFE-State Partnership Exchange model for Arkansas. Some activities (primarily early research) have been completed Early and are providing stateon-specific information. These activities are discussed in detail in going research coupled with guidance from CMS and our CCIIO state officer has supported our efforts to date as well as planning for the previous section of this document. Other activities such as re-working of our web page and many outreach and awareness activities are just getting underway. Delay is related primarily to delayed State Legislative approval for spending the Level One Grant fundsfuture. Arkansas chose to explore implementation of the FFE-State Partnership Exchange model because it allows local development and oversight of the Exchange activities functions that most directly interact with Arkansans and the insurance carriers issuers and producers who do business in our state. From the onset of our planning efforts, we devoted much of our energy and resources to interaction with a wide range of stakeholders and consumer groups. As we continue to nurture grow and grow learn from those relationships, HBEPD feels that we are well positioned has branded the Arkansas Health Connector as a vehicle to represent and assist Arkansans as they negotiate the new Health Insurance Exchange landscape. Arkansas Insurance Department (AID) has a long, successful history of working with and regulating our insurance issuers. We are building on these relationships and regulatory structure as we define our EHB benchmark and the criteria for QHP certification that are compliant with state and federal regulations and in the best interest of our consumers. Throughout all our efforts we are working closely with our sister state agencies, our CCIIO project officer and others at CCIIO, CMS and DHHS to assure adequate, timely collaboration with our Federal partnersMarketplace. As we have learned continue to learn more about the challenges Arkansas faces and the requirements of the FFE PartnershipState Partnership Exchange, we have identified the need for additional resources to increase HBEPD staffing resources, the HBEPD staff, continue utilizing continued utilization of valued consultants, engage new consultants as needed for specialized researchfurther expansion of our outreach activities, expand targeted outreach activities a collaborative endeavor with the State’s Consumer Assistance Program (CAP) to assure consumer access to timely and develop the infrastructure needed to create, operate, monitoraccurate information, and improve a statewide the implementation of the In Person Assister (IPA) program Guide and Arkansas QHP certification and monitoring programprograms. Through this Level One Grant C grant application, Arkansas is seeking funds for identified needs to continue implementation activities in two specific areas of the FFE PartnershipState Partnership Exchange: 1) Consumer and Stakeholder Engagement and Support, and 2) Plan Management. Working together to develop the FFE Partnership Model for Arkansanstogether, we are confident that DHHS and the Arkansas Insurance Department can and will develop implement an efficient, user‐friendly health benefits exchange partnership State Partnership Exchange model that meets our mutual goal of increasing health insurance coverage of low and moderate income Arkansans by making quality, affordable plans easily accessible. The specific activities we plan to undertake with the requested funding are described in the following sections. Current Exchange Pathway As indicated throughout this document, Arkansas is taking deliberate, planned steps to implement the FFE State Partnership Model Exchange model by January 1, 2014 with Open Enrollment October 1, 2013. There are no current plans for a State- State-based Exchange. However, as more well defined regulations and requirements are provided from CCIIO, we will continuously evaluate this stance and assure that the State’s leadership is apprised of any DHHS guidance that could trigger reconsideration of this position. We acknowledge that DHHS views the development of an FFE a State Partnership Exchange as a logical stepping stone to evolve into a State-based Exchange at some future datedate but await direction from our legislators on this issue.