Las Vegas Sun

November 19, 2018

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State to hear companies’ pitches in return to in-house health exchange site

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Heather Korbulic, executive director of the Silver State Health Insurance Exchange, says it has been difficult to bring new insurance carriers into the state when Congress has been debating the repeal and replacement of the Affordable Care Act for seven months.

Presentations are set for today and Tuesday for vendors that are vying to put together the state’s platform for buying health insurance under the Affordable Care Act.

The state invited Get Insured and hCentive to present their technology solutions today, with Maximus, Get Insured and Softheon presenting their customer service plans on Tuesday. Contract negotiations could start by early June, said Heather Korbulic, executive director of the Silver State Health Insurance Exchange.

The technology components will involve the eligibility and enrollment application and how the exchange communicates with federal and state agencies involved, Korbulic said. The customer service component will help the exchange’s 13-person staff with the transition, taking on issues like appeals instead of referring clients to the federal platform for help, which is the current process. Korbulic said the request for proposal weeded out companies that weren’t already successful in the field.

The state will decide in May 2019 whether testing shows the system is ready for open enrollment that year, months before the open enrollment period actually starts. If the technology isn’t ready, Korbulic said, the state will take another year to work out the bugs.

Nevada was one of several states that was unsuccessful in creating a state-run platform, opting to use the federal healthcare.gov platform instead of the technology created by Xerox. A state has never transitioned back from the federal platform, Korbulic said.

“We’re not disrupting carriers, we’re not disrupting our consumers,” Korbulic said. “We are dedicated to making this as seamless as possible, but there will be hiccups. Nothing ever goes perfectly, especially since this has never been done.”

Korbulic said the exchange also plans to go to the Interim Finance Committee on June 20 to ask for the authority to engage a project management office. The exchange wants to use about $500,000 in exchange reserves for project managers, including an information technology specialist, who can troubleshoot the technology.

The Interim Finance Committee recently approved $1 million for the design, development and implementation of the platform. The exchange runs on its own revenue, and Korbulic said no state or federal funds are going into the project.

Cost savings are part of the motivation for the platform transition, Korbulic said. The exchange collects 3.15 percent of its carriers’ premiums. The cost of using the federal platform is increasing to almost 3 percent in 2019, Korbulic said, leaving the exchange with 0.15 percent of what it collects.

The exchange sent a request to Secretary of Health and Human Services Alex Azar that the rate stay at 2 percent while the state transitions to its own platform. That request was denied, Korbulic said, despite the fact that the state will not be burdening the federal platform for 2020 enrollment.

“We’ve budgeted accordingly and we’re a smart agency that’s done what we need to do,” Korbulic said. “But as with anything, it would be more comfortable for us to have those additional funds.”

In addition to cost savings, the state-run platform would allow the exchange to better target customers in need of insurance, and help people follow through on the process. Some customers, Korbulic said, might choose a plan but not pay for it, meaning they haven’t actually obtained coverage. This exchange does not currently have access to this type of data so that they can email customers to let them know they have one more step to complete.

Once a vendor or vendors are chosen and the contract is negotiated, the state’s Board of Examiners is expected to consider the deal in August, Korbulic said. The contract will likely cover a five-year period, with an exit clause so that the exchange can evaluate progress.

“I’m feeling really encouraged about the direction that we’re headed,” Korbulic said. “I’m appropriately anxious about it but I think my confidence level increases every step of the way. We’re being careful not to disrupt our carriers, or anybody if we can.”