Challenge
When the Patient Protection and Affordable Care Act (ACA) was enacted in 2010, a new federal health agency was formed to oversee the implementation of the Health Insurance Marketplaces. This agency, the Center for Consumer Information and Insurance Oversight (CCIIO), is tasked with working closely with state regulators and health insurance issuers to ensure that consumers have an adequate selection of quality and affordable health insurance that complies with the standards set forth by the ACA.
Solution
Atlas Research and Duty First Consulting (Atlas Team) are working together to manage quality assurance and improvement of the Qualified Health Plan (QHP) application, certification, and post-certification processes. In addition to ensuring that the information displayed for consumers on www.healthcare.gov is accurate, the Atlas Team is also responsible for providing CCIIO with clinical support analytical services, particularly regarding non-discriminatory benefit design.
Result
Since September 2013, the Atlas Team has reviewed thousands of QHPs offered in the Federally-facilitated Marketplace. These reviews have involved quality assurance of the non-discrimination reviews for QHP certification, issuer QHP correction notices, consumer access to provider network information, and plan preview data before open enrollment. In terms of operational support, the Atlas Team has worked with states to help develop the 2015 Revised Benchmark Benefit Spreadsheets and has also helped draft several chapters of the Issuer Communications Manual.
With a primary focus on clinical analysis, the Atlas Team has completed several tasks in the interest of individuals with certain health care needs. In early 2014, the Atlas Team developed the first non-discrimination guidance for issuers by providing examples of and possible methods for minimizing potentially discriminatory benefit design. The Atlas Team later supported CCIIO in developing the first Mental Health Parity and Addiction Equity Act (MHPAEA) Review Tool to help states and health insurance issuers quantitatively assess MHPAEA compliance. Furthermore, the Atlas Team is currently developing state-specific Verification Tools as part of CCIIO’s 2017 State Benchmark Plan Selection Workgroup to ensure that new state benchmark and state-required benefit data is accurate and compliant with the standards set forth by the ACA.