In late 2011, the Department of Health and Human Services (HHS) awarded nearly $220 million in Affordable Insurance Exchange grants to 13 states to help them create Exchanges, giving these states more flexibility and resources to implement the Affordable Care Act (ACA). This brings to 29 the number of states that are making significant progress in creating Affordable Insurance Exchanges. States receiving funding include: Alabama, Arizona, Delaware, Hawaii, Idaho, Iowa, Maine, Michigan, Nebraska, New Mexico, Rhode Island, Tennessee, and Vermont.

The health care reform law gives states the freedom to design Affordable Insurance Exchanges – one-stop marketplaces where consumers can choose a private health insurance plan that fits their health needs and have the same kinds of insurance choices as members of Congress.

States have the option of setting up their own exchange, utilizing the federal option, or doing a hybrid model that represents a state-federal partnership. HHS is working on the federal hub that states will have access to if they opt out of a state-run exchange. Stemming from the Affordable Care Act, looming 2014 deadlines for implementation of Health Information Exchanges, pose challenges and opportunities for state agencies.

CNSI solutions help agencies enhance visibility, ensure transparency and implement flexible benefit plans for the benefit of the citizen consumer. Our eCAMS Benefit System provides a robust and comprehensive framework for the design and implementation of benefit plans offerings. The cornerstones of the benefit management features include:

• Benefit Plans - Tailor services to your members with our benefit plans features. Benefit plans can support specific managed care programs. Designing is easy with our step-by-step business process wizards. The plans implement the benefit service packages to define covered services, but also define RAC codes to establish which category of clients can use the specific benefit health plan. Benefit plans include other characteristics such as rates, capacities, assignment factors and coverage areas. Multiple benefit plans may be implemented in the system.
• Benefit Service Package -The Benefit service package defines a bundle of services, diagnosis codes and delivery settings. Our system provides the flexibility to maintain complex benefit packages with rules to include and exclude services. A member may have more than one benefit service package at any given point of time based on their eligibility. Further, these packages can be associated and reused with more than one program. The same benefit service package can be linked with regular fee-for-service programs such as breast and cervical health or managed care programs. Benefit service packages are time dominated with start and end dates to implement automatic time constraints.
• Group Structure - Our flexible group structure provides the flexibility to support exception based processing based on categories of members.
• Business Rules Driven Benefits Evaluation Process - Our integrated RuleIT rules engine manages the business rules associated with evaluating the claim against the multiple benefit service plans and packages, determining hierarchy among benefits plan and benefit service packages and handling exception logic for unique situations.