ACA Marketplace – Executive Digest, 2nd Issue

As we move closer to October 1, 2013, CMS will continue to issue more final and draft rules regarding the implementation of the ACA and Insurance Marketplace. In an effort to assist members, AACHC will provide a monthly summary of some of the issues and rules which may impact your operation.  If you read an interesting article and want to share with your peers or if you have an ACA related question please contact Allen at

In This Issue

  • Obama’s Budget to Spare Medicaid From Deep Cuts
  • Essential Community Providers and Qualified Health Plans
  • Consumer Assistance Programs in Federally Managed Marketplace States
  • Feds Delay Small Business Options Program (SHOP)
  • 21 Graphs That Show America’s Health-care Prices Are Ludicrous
AHCCCS Awards Acute Care and Behavioral Contracts
  • BCS/Banner did not receive a contract for Maricopa county, but Health Net did
  • Mercy Care kept Maricopa and Pima but lost Cochise, Graham and Greenlee
    and United picked these areas up
  • Phoenix Health Plan lost all 5 areas that it has been serving; they appealed and will be able to   keep current members, but new membership will be frozen at October 1, 2013 levels.
  • Care 1st has added Pima and Mercy Care added Cochise, Graham and Greenlee
  • Health Choice will add Gila and Pinal

    Also, the State of Arizona has awarded Mercy Maricopa Integrated Care (MMIC) integrated care contract that includes behavioral health in Maricopa County. AZ Department of Health Services: Division of Behavioral Health Services RBHA Award.

Obama’s budget to spare Medicaid from deep cuts

By Ricardo Alonso-Zaldivar / Associated Press
Posted: April 5, 2013 – 7:45 am ET
President Barack Obama’s budget next week will steer clear of major cuts to Medicaid, including tens of billions in reductions to the health care plan for the poor that the administration had proposed only last year.
Big cuts in the federal-state program wouldn’t go over too well at a time that Health and Human Services Secretary Kathleen Sebelius is wooing financially skittish Republican governors to expand Medicaid coverage to millions who now are uninsured. That expansion in the states is critical to the success of Obama’s health overhaul, which is rolling out this fall and early next year.
Read more: Obama’s budget to spare Medicaid from deep cuts | Modern Healthcare

Essential Community Providers and Qualified Health Plans
Insurance companies (Issuers in the ACA) must apply to sell on the Marketplace and in doing so they must meet requirements to become a Qualified Health Plan (QHP).  Essential Community Providers is one important aspect of QHP network adequacy.  Issuers must apply for QHP by April 30 for consideration.  In a letter dated March 1, 2013, CMS has outlined these requirements in Letter to Issuers on Federally-facilitated and State Partnership Exchanges (for full letter see

FQHCs by definition are ECPs and the March 1 letter requires including 20% of available ECPs in a QHP’s provider network. An alternative minimum of 10% of available ECPs is also described. NACHC has written to CMS strongly advocating for a higher ECP percentage.
John McDonald has worked with NACHC on a Checklist regarding working with Qualified Health Plans (QHP) Issuers. Click here for a copy of the Checklist:  AACHC web address.

Consumer Assistance Programs in Federally Managed Marketplace States
The CMS request for proposals (RFP) regarding Navigator grants should have been released several weeks ago, according to rumors.  It appears “Sequestration” has held up the release of the call for proposals. About ten days ago in a nationwide conference call, top CMS officials stated the RFP should be released within two-weeks.
The following points (gleaned from multiple sources) may provide some useful information:

  • CMS will make a specific amount available for each federally-managed Marketplace. Arizona will not be competing with other states for available funding.
  • There maybe two opportunities to apply for funding; April and September.
  • Entities will most likely be allowed to apply for a geographical area, the entire state and/or a demographic group; i.e. refugees etc.
  • The amount of funding that will be available will likely fall far below original expectations and actual needs.
  • CMS has created a category, Certified Application Counselor (CAC), to denote people who are trained and pass a test but are not receiving Federal Navigator funding. CACs may be very similar to people who are certified by AHCCCS to use Health-e-Arizona.
  • AACHC is working closely with other groups that have a track-record of AHCCCS and KidsCare outreach and discussing how a comprehensive collaborative approach may benefit Arizona.
  • Funding sources to supplement federal funding are being explored by team members.

AACHC will keep you informed when the RFP becomes available.

Setting the record straight on health law’s delayed small business features
By John Arensmeyer on April 4, 2013 at 12:00 pm – for Small Business Majority Blog
Click title for the full article.

The Department of Health and Human Services’ proposal to delay critical requirements for small business health insurance exchanges in some states is a disappointment to Small Business Majority and millions of small businesses. It’s a letdown to small business owners and their employees looking forward to robust, competitive exchanges in 2014. We hope this proposal is recognized as counterproductive and is abandoned.

That said, there’s a tremendous amount of misinformation circulating about what the rule would actually mean. We want to set the record straight.

 21 Graphs That Show America’s Health-care Prices Are Ludicrous

Posted by Ezra Klein on March 26, 2013 at 12:40 pm for The Washington Post
Every year, The International Federation of Health Plans — a global insurance trade association that includes more than 100 insurers in 25 countries — releases survey data showing the prices that insurers are actually paying for different drugs, devices, and medical services in different countries. And every year, the data is shocking.
The IFHP just released the data for 2012. And yes, once again, the numbers are shocking.
This is the fundamental fact of American health care: We pay much, much more than other countries do for the exact same things. For a detailed explanation of why, see this article. But this post isn’t about the why. It’s about the prices, and the graphs.

AACAC Note – these slides are a great resource and may be helpful when making
presentations to staff or the public.