On August 1, 2013, the Washington Office of Insurance Commissioner (OIC) announced that a total of 31 individual health plans had been approved for sale on the Washington Health Benefit Exchange (HBE) for 2014. Of the nine insurance companies that submitted various plans, four companies obtained approval. None of the insurance companies new to Washington were approved and the three Medicaid insurers were rejected. Only one insurer will sell statewide. Kaiser Foundation Plan of the Northwest was the only insurer authorized to sell small group coverage in the SHOP in just Clark and Cowlitz counties in southwest Washington.

The pressure to meet national health care reform deadlines and to demonstrate that health care reform will stay on track has been creating regulatory fissures for some time now. For example, a day after the OIC announced results of its review of Washington health plans, the Office of the Inspector General (OIG) auditors reported that they “could not assess CMS’s efforts to identify security controls and system risks for the [exchange data] and implement safeguards and controls to mitigate identified risks.”

State and federal regulatory staff experience levels of stress that warrant exhaustion of sick leave and employee assistance benefits. With the delay in the large employer mandate, minimal small group participation in the Washington exchange, and limited individual plan offerings, the deadlines seem more important than the outcome.

A perfect demonstration of the pressure to meet deadlines was captured in the following set of Emails sent over the past two days in response to the large number of insurers whose exchange plan filings were rejected. As they say, the messages speak for themselves and are presented with the oldest email first.

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From: MacEwan, Pam
Sent: Tuesday, August 06, 2013 4:30 PM
To: Nollette, Molly (OIC); Odiorne, Jim (OIC)
Cc: Onizuka, Richard (HBE); Kennedy, Lynn (HBE)
Subject: FW: Inquiry regarding Plans in the Exchange

After a few phone calls, I sent the following response to Mel Sorensen. I believe it simply restates our previous statement to the Commissioner, which is that we are respecting your request that we hold the line on the date and that the Commissioner has the authority to add plan approvals. Let us know if you have questions.

Pam MacEwan

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From: MacEwan, Pam
Sent: Tuesday, August 06, 2013 4:21 PM
To: Sorensen, Melvin
Cc: Onizuka, Richard; Kennedy, Lynn
Subject: Inquiry regarding Plans in the Exchange

Mel,

Thanks for your phone call. We’re aware that the Medicaid plans that applied to be offered as QHPs in the Exchange were not successful. I know the timelines were very constrained. To be clear, the July 31st time line was agreed to between the OIC and the Exchange based on advice from CCIIO. It’s not a problem for the Exchange the move the deadline, by a small amount. However, we were advised that it would be a problem for the OIC. However, if the OIC were to approve additional individual exchange plans by August 9th, we would bring them to the Exchange Board for approval. Let me know if you have other questions.

Pam MacEwan |  Chief of Staff
Washington Health Benefit Exchange  |  P.O. Box 657  |  Olympia, Washington 98507

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From: Nollette, Molly (OIC)
Sent: Wednesday, August 07, 2013 9:18 AM
To: Nollette, Molly (OIC)
Subject: FW: Inquiry regarding Plans in the Exchange
Importance: High

Hello – you are receiving this message as your organization’s single point of contact and back up. Please pass this information on to others in your organization as necessary.

 We have received the email below from the Washington Health Benefit Exchange (Exchange). Although the email relates specifically to Medicaid plans, in fairness to all carriers the OIC will interpret it as stating that the Exchange has granted an extension of the Exchange individual market, both QHPs and QDPs, through this Friday, August 9, 2013.

If a carrier wishes to refile for review of products/plans intended for certification as QHPs or QDPs by the Exchange, please take note of the following:

 • Carriers will need to use new HIOS Product IDs and HIOS Plan IDs for all plans that received a final disposition (Approved, Closed, Disapproved and Withdrawn).

 • All plans for the individual market, including plans intended for certification as QHPs or QDPs by the Exchange and plans intended for sale in the outside market only, must be refiled together due to the ACA risk pooling requirements.

 • Forms, rates and binders must be completely refiled. Forms can be cloned with certification that the new filings is identical to the most recently submitted filing.

 • For products and plans that were disapproved, please review the disapproval letter and address the issues identified in the new filings.

Molly Nollette
Deputy Insurance Commissioner
Rates & Forms Division
Washington State Office of the Insurance Commissioner

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From: Nollette, Molly (OIC)
Sent: Wednesday, August 07, 2013 3:55 PM
To: Nollette, Molly (OIC)
Subject: clarification of QHP/QDP individual market deadline
Importance: High

 Hello – you are receiving this message as your organization’s single point of contact and back up. Please pass this information on to others in your organization as necessary.

 Yesterday, the Washington Health Benefit Exchange (WAHBE) communicated to America’s Health Insurance Plans (AHIP) its willingness to consider a plan for Qualified Health Plan (QHP) certification if it were approved by the Office of Insurance Commissioner (OIC) by Friday, August 9. The OIC subsequently communicated that information to the carrier community.

 A firm deadline of July 31 for approval of all plans was set a year ago for good reasons. The OIC needed the time to review the plans and the Exchange needed time to review the recommendations of the OIC.

 The Exchange and the OIC have reviewed the current situation and determined that the initial deadline of July 31 was appropriate, and it is not possible to extend that deadline for individual plans. SHOP plans have received an extension from the Exchange until Tuesday, August 13, and are currently under review by the OIC.

 A number of carriers have requested hearings to review the decision made by the OIC as to their plans. Unfortunately, it is unlikely that any decision resulting from the hearings process would be made until after the federal deadline of August 31 for submission of plans to CMS.

Molly Nollette
Deputy Insurance Commissioner
Rates & Forms Division
Washington State Office of the Insurance Commissioner

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Res Ipsa Loquitur  – This Latin phrase refers to a legal principle of negligence (“the thing speaks for itself”) which holds a person accountable when something goes wrong if you prove the outcome is the type of thing that happens only when someone is negligent, and the negligent person or agency had exclusive control over thing that caused the disaster.

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