State Exchange Profiles: Nebraska
Final update made on December 19, 2013 (no further updates will be made)
Establishing the Exchange
On November 15, 2012, Governor Dave Heineman (R) announced that Nebraska would not establish a health insurance exchange.1Earlier in 2012, the Nebraska legislature introduced two bills (LB 835 and LB 838) to establish a health insurance exchange in Nebraska, however both failed when the legislative session concluded in April.2,3
In 2011, Governor Heineman signed LB 22 into law, which prohibits qualified health insurance plans participating in health insurance exchanges from covering abortions in Nebraska, except when a physician has verified the abortion is necessary to prevent the pregnant woman’s death.4
Prior to Governor Heineman’s announcement, the Department of Insurance (DOI) had explored the possibility of a state-based exchange and released reports summarizing the results of early stakeholder interviews, examining policy options, and analyzing state demographics and the insurance market.5 In addition, the DOI had identified a subcontractor to assist with the planning and design of an exchange, including developing an exchange funding grant application, participating in user group discussions, and developing a cost allocation methodology among state agencies.6
In mid-2012, the DOI described policy assumptions developed through the planning process. Specifically, the assumptions were that Nebraska would have a single state-based exchange, operated within the DOI, which would serve both the individual and small employer markets, though with separate risk pools for the two markets.7 In addition, the exchange would not limit the number of qualified health plans (QHPs). In August and September of 2012, the Governor and DOI held a series of stakeholder meetings and public education sessions to collect public input related to planning an exchange.8
Contracting with Plans: On February 20, 2013, Director of Insurance Bruce Ramge sent a letter to the Center for Consumer Information and Insurance Oversight (CCIIO) requesting to maintain control over plan management functions despite not having entered into a state-federal partnership exchange. The Nebraska Department of Insurance (DOI) has the legal authority and operational capacity to oversee certification of Qualified Health Plans (QHPs). DOI will collect and analyze information on plan rates, covered benefits, and cost-sharing requirements. DOI will also ensure continued plan compliance, manage consumer complaints, and oversee decertification of issuers.9
On March 21, 2013, the state’s Department of Insurance issued a bulletin that spells out the requirements for qualified health plans seeking to sell coverage through the exchange.10 According to the bulletin, insurers must submit their applications by April 30th and plans will be approved by July 31, 2013.
Consumer Assistance and Outreach: The DOI had made development of a marketing and outreach strategy a key next step in the planning process. In addition, the DOI described an approach to the Navigator program and the roles of agents and brokers.11
In addition, Nebraska had planned to establish a call center in the state to respond to inquiries from consumers, Navigators/Assisters, and agents/brokers.12 The call center would have been dedicated to the individual and small business health options program (SHOP) exchanges only, and any questions regarding Medicaid and the Children’s Health Insurance Program (CHIP) transferred to the existing call center in the Nebraska Department of Health and Human Services.
Information Technology (IT): In 2011, the DOI coordinated with the Nebraska Department of Health and Human Services to review the state’s current IT capabilities and operational procedures.13 That same year, the DOI used a Request for Proposals (RFP) to procure subcontractor assistance with the early stages of development, design, and creation of an enrollment, verification, and eligibility IT system for an exchange.14 In March 2012, the DOI released a Request for Information (RFI) for assistance with a cost analysis of current third-party IT platforms and turn-key solutions, components, and services that would be interoperable with existing federal and state systems.15
In September 2012, the state released an RFP for subcontractor assistance with development of multiple components of an exchange’s IT system, including a consumer portal, the enrollment and eligibility system, a case management system, and the business rules engine.16 The contract would have been awarded for a minimum of five years and include both development and maintenance services, though state IT or exchange staff were expect to operate and managed the systems once operational.
Essential Health Benefits (EHB): The ACA requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. Based on a subcontractor analysis, actuarial study, and stakeholder insight, the DOI planned to recommend to the Governor that the state’s EHB benchmark plan be Nebraska’s current largest small group plan, Blue Cross Blue Shield of Nebraska- Blue Pride.17 On October 1, 2012, Governor Heineman selected a “Nebraska Option” for the state’s EHB plan.18 However, the plan was not approved by the federal Department of Health and Human Services and the state’s benchmark EHB plan defaulted to Blue Cross Blue Shield of Nebraska- Blue Pride PPO.
Exchange Funding
The Nebraska Department of Insurance received a federal Exchange Planning grant of $1 million in 2010. In November 2011, the Department of Insurance was also awarded a $5.5 million federal Level One Establishment grant to further plan and design an exchange for the state.19
Next Steps
On March 8, 2013, Nebraska received approval from CCIIO to perform plan management activities. The federal government will retain control over all other Exchange functions.20
1. Governor Dave Heineman’s Remarks, November 15, 2012.http://www.governor.nebraska.gov/news/2012/11/pdf/Federal_Health_Insurance_Exchange.pdf
2. LB 835. Nebraska’s 2012 Health Benefits Exchange Act.http://nebraskalegislature.gov/FloorDocs/Current/PDF/Intro/LB835.pdf
3. LB 838. Nebraska’s 2012 Health Benefit Exchange Act.http://nebraskalegislature.gov/FloorDocs/Current/PDF/Intro/LB838.pdf
4. LB 22. Nebraska’s Mandate Opt-Out and Insurance Coverage Clarification Act of 2011.http://nebraskalegislature.gov/FloorDocs/Current/PDF/Slip/LB22.pdf
5. “Health Insurance Exchange Planning Overview and Recommendations.” Nebraska Department of Insurance. October 2011. http://www.doi.ne.gov/healthcarereform/exchange/Health_Insurance_Exchange_Planning.pdf
6. Nebraska Department of Insurance RFP 12-002Z1, Selection a qualified contractor to provide continued planning and design of the potential exchange. March 12, 2012 http://www.doi.ne.gov/rfp/RFP_12-002Z1/RFP_12-002Z1.pdf
7. Presentation by the Nebraska Department of Insurance. “State of Nebraska’s Health Insurance Exchange: A Presentation to the Public.” September 2012.http://www.statereforum.org/sites/default/files/nebraska_public_meetings_9-14-12.pdf
8. Press release from the office of Governor Heineman. “Gov. Heineman Announces Informal Public Meetings to Discuss Health Insurance Exchanges.” August 15, 2012.http://www.governor.nebraska.gov/news/2012/08/15_health_ins.html
9. Letter from Director Ramge to Gary Cohen. February 20, 2013. http://cciio.cms.gov/Archive/Technical-Implementation-Letters/ne-exchange-letter-2-20-2013.pdf
10. Nebraska Department of Insurance, “Filing Individual and Small Employer Health and Dental Plans in Nebraska,” March 21, 2013. http://www.doi.nebraska.gov/bulletin/cb130.pdf
11. Presentation by the Nebraska Department of Insurance. “State of Nebraska’s Health Insurance Exchange: A Presentation to the Public.” September 2012.
12. Nebraska Request for Proposal. RFP #4119Z1. September 14, 2012.http://www.das.state.ne.us/materiel/purchasing/RFP4119.pdf
13. Nebraska: Healthcare Exchange Planning. Grant #1 HBEIE100048-0101. Reporting Quarter 07/01/2011-09/30/2011. http://www.doi.ne.gov/healthcarereform/exchange/quarterly_reports/2011.09.30.pdf
14. Nebraska Department of Insurance RFP 11-001Z1, Exchange Planning Information Technology (IT) Consulting Services. March 7, 2011. http://www.doi.ne.gov/rfp/11-001Z1/RFP_11-001Z1.pdf
15. Nebraska Department of Insurance RFP 12-001Z1, HIX Information Technology Solution. March 7, 2011http://www.doi.ne.gov/rfp/RFI_12-001Z1/RFI_12-001Z1.pdf
16. Nebraska Request for Proposal. RFP #4119Z1. September 14, 2012.
17. Nebraska Department of Insurance. “Presentation to the Banking, Commerce, and Insurance Committee.” September 14, 2012. http://www.statereforum.org/sites/default/files/nebraska_unicameral_9-14-12.pdf
18. Press release. “Governor Heineman Submits ‘Nebraska Option’ for Obamacare Deadline.” October 1, 2012.http://www.governor.nebraska.gov/news/2012/10/01_ne_option.html
19. Centers for Medicare & Medicaid Services. “Creating a New Competitive Marketplace: Health Insurance Exchange Establishment Grants Awards List.”http://www.healthcare.gov/news/factsheets/2011/05/exchanges05232011a.html (Accessed November 29, 2011).
20. Letter from Gary Cohen to Director Ramge. March 8, 2013. http://cciio.cms.gov/Archive/Technical-Implementation-Letters/ne-pm-letter-3-8-2013.pdf