Common use of SHOP Clause in Contracts

SHOP. 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 Marketplace. Based on expressed concern that employers would drop coverage after Marketplaces are introduced, ACHI prepared a policy brief in August, 2011, titled, “Will Employers Drop, Keep, or Add Health Insurance in 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. Since hiring the Plan Management Specialist, AHCD has been actively engaged with CCIIO and CMS to ensure a successful implementation of the SHOP program with the federal government. The individual and SHOP markets will be separate as part of the SPM model. 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 SHOP. ASBTDC will work closely with the Small Business Administration regional office and the state and local xxxxxxxx of commerce. PROPOSAL TO MEET PROGRAM REQUIREMENTS Building on the work of the last two-plus years funded by our Planning Grant (awarded September 2010 with Administrative Supplement awarded March 2012), Level One A grant (awarded February 2012), Level One B grant (awarded September 2012), and Level One C grant (awarded April 2013), ACHD is making systematic, steady progress toward implementing the State Partnership Marketplace (SPM) model for Arkansas. Early and on-going research coupled with guidance from CMS and our CCIIO state officer has supported our efforts as well as helped us plan for the future. Arkansas chose the SPM model because it allows local development and oversight of the functions that most directly interact with Arkansans, and the insurance 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 grow and learn from those relationships, AHCD has branded the Arkansas Health Connector as a vehicle to represent and assist Arkansans as they negotiate the new Health Insurance Marketplace. As we continue to learn more about the challenges Arkansas faces and the requirements of the SPM, we have identified additional needs. With this Level One D grant application, AHCD in summary is seeking funds 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 of continuity of coverage plans Working together, we are confident that HHS and AID can, and will, implement and improve an efficient, user-friendly SPM model that meets our mutual goal of increasing health insurance coverage for 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 SPM model by January 1, 2014 with open enrollment starting October 1, 2013. 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 SBM. That decision will be up to the newly-appointed Board of Directors of the Arkansas Health Insurance Marketplace, 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-defined regulations and requirements are provided from CCIIO, we will assist the Board in any way it sees fit as the members evaluate the best model for Arkansas. We will ensure that the state’s leadership is apprised of any HHS guidance that could trigger reconsideration of this position. We acknowledge that HHS views the development of a SPM as a logical stepping stone to evolve into 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. AHCD 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 MarketplaceExchange. Based on expressed concern that employers would drop coverage after Marketplaces Exchanges are introduced, ACHI 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 xxxx://xxx.xxxx.xxx/HCR%20Docs/110808%20ISSUE%20BRIEF%20EMPLOYER%20RESPONSE.pdf.The brief 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, AHCD HBEPD has been actively engaged with CCIIO and CMS to ensure a successful implementation of the SHOP program with the federal government. The 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 SPM modelFFE Partnership Model. As We await guidance on Agent/Broker training and FFE “certification” requirements for 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 SHOP. ASBTDC will work closely with the Small Business Administration regional office and the state and local xxxxxxxx of commerce. PROPOSAL TO MEET PROGRAM REQUIREMENTS Building on the work of the last two-plus almost two years funded and using funds provided by our Planning Grant (awarded September 2010 9/30/10 with Administrative Supplement awarded March 2012), Level One A grant (awarded February 2012), Level One B grant (awarded September 2012), 3/8/12) and Level One C grant Grant (awarded April 20132/22/12), ACHD the HBEPD is making systematic, steady progress toward implementing the State FFE-Partnership Marketplace (SPM) model for Arkansas. Early Some activities (primarily early research) have been completed and onare providing state-going research coupled with guidance from CMS 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 our CCIIO state officer has supported our efforts as well as helped us plan many outreach and awareness activities are just getting underway. Delay is related primarily to delayed State Legislative approval for spending the futureLevel One Grant funds. Arkansas chose to explore implementation of the SPM FFE-Partnership model because it allows local development and oversight of the functions Exchange activities that most directly interact with Arkansans, Arkansans and the insurance issuers and producers 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-wide range of stakeholders and consumer groups. As we continue to nurture and grow and learn from those relationships, AHCD has branded the Arkansas Health Connector as a vehicle HBEPD feels that we are well positioned to represent and assist Arkansans as they negotiate the new Health Insurance MarketplaceExchange 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 continue to learn have learned more about the challenges Arkansas faces and the requirements of the SPMFFE Partnership, we have identified the need for additional needsresources 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. With Through this Level One D grant Grant application, AHCD in summary Arkansas is seeking funds forfor identified needs to continue implementation activities in two specific areas of the FFE Partnership:  Additional staffing resources  The continued utilization of valued 1) Consumer and necessary consultants  Extension of our statewide Stakeholder Engagement and deep outreach activities  Continuation of our far-reaching IPA services  Further development of our comprehensive Qualified Health Support, and 2) Plan (QHP) certification, recertification and monitoring processes  Further study and implementation of continuity of coverage plans Management. Working togethertogether to develop the FFE Partnership Model for Arkansans, we are confident that HHS DHHS and AID can, Arkansas can and will, implement and improve will develop an efficient, user-friendly SPM model user‐friendly health benefits exchange partnership that meets our mutual goal of increasing health insurance coverage for low- of 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 SPM model FFE Partnership Model by January 1, 2014 with open enrollment starting Open Enrollment October 1, 2013. 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 There are no current plans for a SBMState- based Exchange. That decision will be up to the newly-appointed Board of Directors of the Arkansas Health Insurance MarketplaceHowever, 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 as more well-well defined regulations and requirements are provided from CCIIO, we will assist the Board in any way it sees fit as the members continuously evaluate the best model for Arkansas. We will ensure this stance and assure that the stateState’s leadership is apprised of any HHS DHHS guidance that could trigger reconsideration of this position. We acknowledge that HHS DHHS views the development of a SPM an FFE Partnership as a logical stepping stone to evolve into an SBM a State-based Exchange 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. AHCD 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 MarketplaceExchange. Based on expressed concern that employers would drop coverage after Marketplaces Exchanges are introduced, ACHI 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 xxxx://xxx.xxxx.xxx/HCR%20Docs/110808%20ISSUE%20BRIEF%20EMPLOYER%20RESPONSE.pdf.The brief 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 as part of Phase 1 of our outreach and education campaign. Since hiring the Plan Management Specialist, AHCD HBEPD has been actively engaged with CCIIO and CMS to ensure a successful implementation of the SHOP program with the federal government. The 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 SPM modelState Partnership Exchange Model. As We await guidance on Agent/Broker training and FFE “certification” requirements for 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 SHOP. ASBTDC will work closely with the Small Business Administration regional office and the state and local xxxxxxxx of commerce. PROPOSAL TO MEET PROGRAM REQUIREMENTS Building on the work of the last two-plus years funded and using funds provided by our Planning Grant (awarded September 2010 9/30/10 with Administrative Supplement awarded March 20123/8/12), Level One A grant (awarded February 2012), 2/22/12) and Level One B grant (awarded September 20129/27/12), and Level One C grant (awarded April 2013), ACHD HBEPD is making systematic, steady progress toward implementing the State Partnership Marketplace (SPM) Exchange model for Arkansas. Early and on-going research coupled with guidance from CMS and our CCIIO state officer has supported our efforts to date as well as helped us plan planning for the future. Arkansas chose the SPM State Partnership Exchange model because it allows local development and oversight of the functions that most directly interact with Arkansans, Arkansans and the insurance 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 grow and learn from those relationships, AHCD HBEPD has branded the Arkansas Health Connector as a vehicle to represent and assist Arkansans as they negotiate the new Health Insurance Marketplace. As we continue to learn more about the challenges Arkansas faces and the requirements of the SPMState Partnership Exchange, we have identified the need for additional needs. With this Level One D grant applicationHBEPD staffing resources, AHCD in summary is seeking funds for:  Additional staffing resources  The the continued utilization of valued and necessary consultants  Extension consultants, further expansion of our statewide outreach activities, a collaborative endeavor with the State’s Consumer Assistance Program (CAP) to assure consumer access to timely and deep outreach activities  Continuation accurate information, and the implementation of our far-reaching IPA services  Further development of our comprehensive Qualified Health Plan the In Person Assister (QHPIPA) certification, recertification Guide and QHP certification and monitoring processes  Further study programs. Through this Level One C grant application, Arkansas is seeking funds to continue implementation activities in two specific areas of the State Partnership Exchange: 1) Consumer and implementation of continuity of coverage plans Stakeholder Engagement and Support, and 2) Plan Management. Working together, we are confident that HHS DHHS and AID can, the Arkansas Insurance Department can and will, will implement and improve an efficient, user-friendly SPM user‐friendly State Partnership Exchange model that meets our mutual goal of increasing health insurance coverage for low- of 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 SPM State Partnership Exchange model by January 1, 2014 with open enrollment starting Open Enrollment October 1, 2013. 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 There are no current plans for a SBMState-based Exchange. That decision will be up to the newly-appointed Board of Directors of the Arkansas Health Insurance MarketplaceHowever, 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 as more well-well defined regulations and requirements are provided from CCIIO, we will assist the Board in any way it sees fit as the members continuously evaluate the best model for Arkansas. We will ensure this stance and assure that the stateState’s leadership is apprised of any HHS DHHS guidance that could trigger reconsideration of this position. We acknowledge that HHS DHHS views the development of a SPM State Partnership Exchange as a logical stepping stone to evolve into an SBM a State-based Exchange at some future date. We date but 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 needsour legislators on this issue.

SHOP. 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 Marketplace. Based on expressed concern that employers would drop coverage after Marketplaces are introduced, ACHI prepared a policy brief in August, 2011, titled, “Will Employers Drop, Keep, or Add Health Insurance in 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 (MercerXxxxxx, McKinseyXxXxxxxx, 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. Since hiring the Plan Management Specialist, AHCD has been actively engaged with CCIIO and CMS to ensure a successful implementation of the SHOP program with the federal government. The individual and SHOP markets will be separate as part of the SPM model. 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 SHOP. ASBTDC will work closely with the Small Business Administration regional office and the state and local xxxxxxxx of commerce. PROPOSAL TO MEET PROGRAM REQUIREMENTS Building on the work of the last two-plus years funded by our Planning Grant (awarded September 2010 with Administrative Supplement awarded March 2012), Level One A grant (awarded February 2012), Level One B grant (awarded September 2012), and Level One C grant (awarded April 2013), ACHD is making systematic, steady progress toward implementing the State Partnership Marketplace (SPM) model for Arkansas. Early and on-going research coupled with guidance from CMS and our CCIIO state officer has supported our efforts as well as helped us plan for the future. Arkansas chose the SPM model because it allows local development and oversight of the functions that most directly interact with ArkansansXxxxxxxxx, and the insurance 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 grow and learn from those relationships, AHCD has branded the Arkansas Health Connector as a vehicle to represent and assist Arkansans Xxxxxxxxx as they negotiate the new Health Insurance Marketplace. As we continue to learn more about the challenges Arkansas faces and the requirements of the SPM, we have identified additional needs. With this Level One D grant application, AHCD in summary is seeking funds 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 of continuity of coverage plans Working together, we are confident that HHS and AID can, and will, implement and improve an efficient, user-friendly SPM model that meets our mutual goal of increasing health insurance coverage for 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 SPM model by January 1, 2014 with open enrollment starting October 1, 2013. 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 SBM. That decision will be up to the newly-appointed Board of Directors of the Arkansas Health Insurance Marketplace, 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-defined regulations and requirements are provided from CCIIO, we will assist the Board in any way it sees fit as the members evaluate the best model for Arkansas. We will ensure that the state’s leadership is apprised of any HHS guidance that could trigger reconsideration of this position. We acknowledge that HHS views the development of a SPM as a logical stepping stone to evolve into 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.