Health Insurance Exchange Act
inaugural Board Meeting
April 29 – 30, 2013
Background:
New Mexico Health Insurance Exchange Act
Introduced by: Senator Bennie Shendo (SB 221)The New Mexico Health Insurance Exchange is a nonprofit public corporation which provides qualified individuals and qualified employers with increased access to health insurance. It is governed by a board of directors. The Board is required to:
1. Shall meet no less often than once per calendar quarter.
2. Shall create and make appointments to an advisory committee(s) made up of stakeholders, including health insurance issuers, health care consumers, health care employer representatives and advocates for low-income or underserved residents.
3. Shall create a committee made up of members insured through the New Mexico health insurance alliance and the New Mexico medical insurance pool. This committee shall exist only until a transition plan has been adopted by the Board.
4. Shall create an advisory committee made up of Native Americans (on and off-reservation) to guide the implementation of the Native American-specific provisions of the federal Patient Protection and Affordable Care Act and the federal Indian Health Care Improvement Act.
5. Designate a Native American liaison to assist the Board in developing and ensuring implementation of communication and collaboration between the exchange and Native Americans in the state. The liaison shall serve as a contact person between the exchange and tribes and shall ensure that training is provided to the staff of the exchange which may include a) cultural competency; b) state and federal law relating to Indian health; and c) other matters relating to the functions of the exchange with respect to Native Americans in the state.
6. Shall establish at least one walk-in customer service center where persons may, if eligible, enroll in qualified health plans or public coverage programs.
The Board may:
1. Seek and receive grant funding from federal, state or local governments or private philanthropic organizations to defray the costs of operating the exchange.
2. Generate funding, including charging assessments or fees, to support its operations in accordance with the provisions of the New Mexico Health Insurance Exchange Act solely for the reasonable administrative costs of the exchange.
3. Establish a Native American service center to ensure that the exchange is a) accessible to Native Americans; b) complies with the provisions of the federal Indian health Care Improvement Act and Indian-specific provisions of the federal Patient Protection and Affordable Care Act; and c) facilitates meaningful, ongoing consultation with Native Americans.
4. Create ad hoc advisory councils.
5. Request assistance from other boards, commissions, departments, agencies and organizations as necessary to provide appropriate expertise to accomplish the exchange’s duties.
6. Enter into contracts with persons or other organizations as necessary or proper to carry out the provisions and purposes of the New Mexico health insurance exchange.
7. Enter into contracts with similar exchanges of other states for the joint performance of common administrative functions.
8. Enter into information-sharing agreements with federal and state agencies and other state exchanges to carry out its responsibilities; provided these agreements include adequate protections of the confidentiality of the information to be shared and comply with all state and federal laws and regulations
9. Sue or be sued or otherwise take any necessary or proper legal action in the execution of its duties and powers.
10. Appoint board committees, which may include non-board members, to provide technical assistance in the operation of the exchange and any other functions within the authority of the exchange.
11. Conduct periodic audits to assure the general accuracy of the financial data submitted to the exchange.
(for full text of the Act to New Mexico Legislator – Bill Finder)
HIX Board elections/appointments:
Officers:J. R. Damron, M.D., Chairman, (Santa Fe) staff radiologist in the Dept. of Radiology at UNM School of Medicine, Board of Directors for New Mexico Health Insurance AllianceJason Sandell, Vice-Chairman, (Farmington) Vice-President, Aztec Well ServicingPatsy Romero, Treasurer, (Santa Fe) COO, Easter Seals El Mirador, State President of National Alliance for the Mentally Ill
Committee Chairs:Patsy Romero, Operations and Benefits
Martin Hickey, (Albuquerque) Marketing and Public Relations, CEO of New Mexico Health ConnectionsBen Slocum, (Albuquerque) Information Technology, President and CEO, Lovelace Health PlanTeresa Gomez, (Albuquerque – Isleta Pueblo) Native American, CEO, Futures for Children
The Board decided to establish a Native American Standing Committee. A standing committee is
a permanent committee dealing with a designated subject. Gomez recommended the retention
of the NA Advisory Committee but that it be incorporated into the standing committee. The
recommendation was supported by Chairman Damron and Treasurer Romero.
Chairman Damron identified five core functions of the Health Insurance Exchange.
1. Eligibility
2. Enrollment
3. Plan management (Qualified Health Plans [QHP])
4. Consumer assistance: Navigators and In-person assistants
5. Financial management
The design of the health insurance exchange is based on the Office of Personnel Management’s (OPM)model that allows Federal employees a choice of health benefits’ plans.
Actions taken re funding:
1. Held discussion about transfer of funds from Health Insurance Alliance which could not be done until the HIX completed appointments. In meantime would use an MOU to draw down funds for operation.
2. The exchange will be funded through a contract with the Human Services Department or any other state agency that receives federal money for the purpose of planning, implementation or operation of a health insurance exchange.
3. There is sufficient money for initial operation of the exchange from initial $32m grant funds.
4. Decision made to apply for $20m in federal funds to cover initial costs of outreach. Application deadline is May 15, 2013.
Plan of Operation:
The Exchange is required to create a preliminary plan of operation within sixty days of its effective date to ensure fair, reasonable and equitable administration of the exchange. The effective date is May 30. Within six months of the effective date, the Board is required to create and implement a final plan of operation containing provision to ensure the fair, reasonable and equitable administration of the Exchange. Both public notice and a hearing are required before approval of the plan of operation. The preliminary plan shall:
1. Establish procedures to implement provisions of the Exchange consistent with state and federal law
2. Establish procedures for handling and accounting for the Exchange’s assets and money.
3. Establish regular times and meeting places for meetings of the Board.
Final Plan of Operation:
1. Establish a statewide consumer assistance program, including a navigator program.
2. Establish procedures for handling and accounting for the exchange’s assets and money.
3. Establish procedures for alternative dispute resolution between the exchange and contractors or health insurance issuers.
4. Develop and implement policies that:
a) promote effective communication and collaboration between the exchange and Indian
nations, tribes and pueblos, including communicating and collaborating on those nations’,
tribes’ and pueblos’ plans for creating or participating in health insurance exchanges.
b) promote cultural competency in providing effective services to Native Americans.
5. Establish conflict-of-interest policies and procedures.
6. Contain additional provisions necessary and proper for the execution of the powers and duties of
board.
