Nevada Coverage & Market Stabilization Program


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    Background - Improving Health Care Coverage One Piece at a Time

    Passed during the 2021 Legislative Session, Nevada Senate Bill 420 requires the Director of the Department of Health and Human Services (DHHS), in consultation with the Commissioner of Insurance and the Executive Director of the Silver State Health Insurance Exchange, to design, establish, and operate new health plans.

    Under this new coverage program, the Director must contract with health issuers to offer new state-contracted health plans to individuals who purchase their own health insurance. These new plans will be referred to as Battle Born State Plans (BBSPs). To comply with state law, the Director must offer the new BBSPs to consumers for purchase at Nevada Health Link (Nevada's Health Insurance Exchange) no later than January 1, 2026.

    The new BBSPs will, for the most part, mirror other health plans sold on Nevada Health Link, with the same minimum benefits and cost-sharing requirements. They must also meet all the same state and federal requirements as other non-group health plans. The major difference is that the BBSPs must meet a premium reduction target to improve consumer affordability and satisfy all state goals and requirements set forth in the new contracts with issuers for this market.

      Market Stabilization Program

      To mitigate risks to providers and the marketplace with this new reform, Governor Joe Lombardo is seeking all necessary federal authority and funding as described below to establish a Market Stabilization Program. These new initiatives aim to protect the State's marketplace and ensure it remains a healthy and stable marketplace for Nevadans.

      The key components of this program, if approved, will include:

      1. State-Based Reinsurance Program: A reinsurance program acts as "insurance for the issuers", subsidizing the cost of high-cost claims in the market. The reinsurance program, as designed by Nevada's waiver, will be the first in the nation to be fully funded by the federal government. A reinsurance program will alleviate financial risk to health issuers and their provider networks with the introduction of the new BBSPs. If approved, this new program will begin no later than January 1, 2027.
      2. Quality Incentive Program (QIP) for Issuers: The QIP is designed to reward issuers and their provider networks with an annual bonus payment for utilizing value-based efforts to improve health outcomes and quality of care for consumers. Over time, these efforts are expected to lead to system savings with greater efficiencies and a healthier population.
      3. "Practice in Nevada" Incentive Program for Health Care Providers: This new program will offer loan repayment options to providers who are willing to live and work in Nevada for at least four years. If a provider does not stay for the full four years, then the provider must pay back the full amount of the loan repayment from the State.

      For questions, write to 1332WaiverProgram@dhcfp.nv.gov.

        1332 Waiver Application

        State law requires the Director to seek a Section 1332 Waiver of the Affordable Care Act to implement the new BBSPs and to capture any savings to the federal government because of the BBSPs. The Director must submit this waiver no later than January 1, 2024. Below is a link the State's submitted 1332 Waiver Application on December 29, 2023.

        As described above, any federal savings received by the State for the new BBSPs will be used to finance a new Market Stabilization Program. To be approved, the waiver must provide coverage that is at least as comprehensive as the coverage provided without the waiver; provide coverage and cost-sharing protections against excessive out-of-pocket spending that are at least as affordable as without the waiver; provide coverage to at least a comparable number of residents as without the waiver; and not increase the federal deficit.

          Next Steps: 1332 Waiver Application

          Update February 13, 2024: The federal Centers for Medicare & Medicaid Services (CMS) and the Department of the Treasury have determined Nevada’s Section 1332 waiver application complete and opened a 30-day federal public comment period. Due to web issues delaying federal posting until today, the 30-day federal public comment period has been extended to March 14, 2024. To submit a public comment, please email stateinnovationwaivers@cms.hhs.gov. The CMS notice is available for review here.

           

            February 12, 2024: The federal Centers for Medicare & Medicaid Services (CMS) and the Department of the Treasury have determined Nevada’s Section 1332 waiver application complete and opened a 30-day federal public comment period.

            Next Steps: 1332 Waiver Application Addendum

            Update August 23, 2024: Nevada submitted a revised 1332 waiver application to the U.S. Department of Treasury and U.S. Department of Health and Human Services. Federal public comments will be accepted from August 26, 2024, through September 25, 2024; the revised application is also available for review here. And more information may be found on the CMS website here.

            On March 21, 2024, Nevada requested that the Departments pause review of the waiver application. On August 23, 2024, Nevada submitted an updated waiver application and review of the waiver resumed. The final decision of the Secretaries of HHS and the Treasury will be issued no later than January 11, 2025, given that final decisions are issued 180 days after the determination is made that an application is complete and that Nevada paused review of their waiver on day 39 of the 180-day review.

              Public Comment on the 1332 Waiver

              The formal public comment period for the 1332 Waiver Application and Actuarial Analysis of the Nevada Coverage and Market Stabilization Program took place for a 30-day period, from November 20th, 2023 to December 20, 2023. Below is a link to view all written public comments received during this formal public comment period.

              The Division of Health Care Financing and Policy (DHCFP, Nevada Medicaid) hosted two public meetings where state staff presented a summary of the 1332 Waiver Application and Actuarial Analysis and collected public feedback. The meetings offered both virtual and in-person options for attendance. Meeting information can be found below. To submit written comments on the 1332 Waiver Application and Actuarial Analysis, please email: 1332WaiverProgram@dhcfp.nv.gov

              Stay Informed

              Sign up for the Nevada Market Stabilization Program ListServ and receive emails regarding meetings, documents, and presentations. We will not share your information and the number of emails is minimal.

            • To join the notification list for the Nevada Market Stabilization Program, simply click here and send the email. If you experience challenges signing up, write to the Market Stabilization Team 1332WaiverProgram@DHCFP.nv.gov.
              • Additional Information

                SB420 requires the Director of the Department of Health and Human Services to apply for a Section 1332 State Innovation Waiver. For more information, the Centers for Medicare & Medicaid Services has a page dedicated to Section 1332: State Innovation Waivers.

                Archive Materials

                Starting in 2021, DHCFP hosted several public meetings, design sessions with stakeholders, weekly office hours, and produced presentations and reports for interested parties about the new plans.

                Meetings

                Physical location Originating Site | Call in to teleconference Teleconference remote site | Remote viewing of conference online Video Conference remote site | View events and/or documents online View Online
                DateLocationAgendaMinutesAttachments
                NRS 695K requires health insurance carriers that wish to submit a bid as a Medicaid managed care organization to offer state-contracted health plans (Battle Born State Plans or BBSPs) through the Silver State Health Insurance Exchange. BBSPs must meet a premium reduction target. This call will explain the development of the reference premiums, the calculation of premium reduction targets, and responses to data requests. This call is intended for prospective BBSP and Medicaid managed care bidders. Attendance at the call is a required element of a valid Letter of Interest to progress in the BBSP procurement. More information on the BBSP procurement can be found in the RFP Step One here.
                08/14/2024
                10:00 AM - 11:30 AM PDT
                Dec. 5, 2023, 1332 Waiver Application Presentation and Public Comment Meeting
                12/05/2023
                1:00 PM - 3:00 PM
                originate104 - 1210 S. Valley Blvd - Las Vegas
                Dec. 5, 2023 1332 Waiver Application Presentation and Public Comment Agenda1332 Waiver Actuarial Analysis (Full Report)1332 Waiver ApplicationMeeting Presentation for 1332 Waiver Application and Actuarial AnalysisMeeting Recording for the December 5 2023 1332 Waiver Application and Actuarial Analysis Public Comment Meeting
                Nov. 27, 2023, 1332 Waiver Application Presentation and Public Comment Meeting
                11/27/2023
                01:00 PM - 3 PM
                originate303 - DPBH 4150 Technology Way - Carson City
                11/27/2023 Agenda1332 Waiver Application1332 Waiver Actuarial Analysis (Full Report)Meeting Presentation for 1332 Waiver Application and Actuarial AnalysisMeeting Recording for the November 27 2023 1332 Waiver Application and Actuarial Analysis Public Comment Meeting
                Stakeholder Engagement & Waiver Design Public Meeting
                01/28/2023
                01:00 PM - 02:00 PM
                - Licensure and Oversight -
                - Offering the Public Option in the small group market -
                - Next Steps (actuarial analysis, subsequent opportunities for stakeholder feedback, waiver development) -
                1/28/2023 Video Recording
                For updates please join the Nevada Market Stabilization ListServ mentioned in the right-hand column above.
                Stakeholder Engagement & Waiver Design Public Meeting
                01/18/2023
                12:00 PM - 01:00 PM
                - Health plan rate setting and rate review -
                - Provider contracting and networks -
                - Strengthening the Individual and Small Group Markets -
                1/18/2023 Video Recording
                Stakeholder Engagement & Waiver Design Public Meeting
                01/13/2023
                01:00 PM - 02:00 PM
                - Benefits -
                - Value-Based Payment / Cost Containment -
                1/13/2023 Video Recording
                Stakeholder Engagement & Waiver Design Public Meeting
                01/05/2023
                02:00 PM - 03:00 PM
                - Target population -
                - Affordability: Cost-Sharing and Premiums -
                1/5/2023 Video Recording
                Stakeholder Engagement & Waiver Design Public Meeting
                12/22/2022
                02:00 PM - 03:00 PM
                - Stakeholder Priorities for the Design of This Public Option (e.g., affordability, networks, access, provider reimbursement, etc.) -
                12/22/2022 Video Recording
                Stakeholder Engagement & Waiver Design Public Meeting
                12/08/2022
                02:00 PM - 03:00 PM
                - Goals and Guiding Principles -
                - Overview of Legislation and 1332 Waivers -
                - Overview of Public Option Designs in Other States -
                12/8/2022 Video Recording
                Actuarial Study Informational Webinar
                09/23/2022
                Watch the Video Recording of the MeetingPreliminary Actuarial Study Presentation
                Public Option Design Session 6
                01/28/2022
                01:00 PM
                phone - 888-788-0099 (Toll Free), 941 0586 1099 -
                1/28/2022 Agenda1/28/2022 Presentation1/28/2022 Public Comment1/28/2022 Henderson Chamber of Commerce Public Comment1/28/2022 Recording of Meeting
                Public Option Design Session 5
                01/18/2022
                012:00 PM
                phone - 888-788-0099 (Toll Free), 941 0586 1099 -
                1/18/2022 Agenda1/18/2022 Presentation1/18/2022 Recording of Meeting
                Public Option Design Session 4
                01/13/2022
                01:00 PM
                phone - 888-788-0099 (Toll Free), 941 0586 1099 -
                1/13/2022 Agenda1/13/2022 Presentation1/13/2022 Recording of Meeting1/13/2022 Public Comment, NHA Coalition1/13/2022 Public Comment
                Public Option Design Session 3
                01/05/2022
                02:00 PM
                phone - 888-788-0099 (Toll Free), 941 0586 1099 -
                1/5/2022 Agenda1/5/2022 Presentation1/5/2022 NV Deserves Public Comment1/5/2022 Public Option Emails1/5/2022 Recording of Meeting
                Public Option Design Session 2
                12/22/2021
                02:00 PM
                phone - 888-788-0099 (Toll Free), 941 0586 1099 -
                12/22/2021 Agenda12/22/2021 Presentation12/22/2021 Recording of Meeting 12/22/2021 NHA Public Comments12/22/2021 NVAHP Public Comments
                Public Option Design Session 1
                12/08/2021
                2:00 PM
                phone - 888-788-0099 (Toll Free), 941 0586 1099 -
                12/8/2021 Agenda12/8/2021 Coalition Letter12/8/2021 Presentation12/8/2021 Public comment letterPO Letter 12/812/8/2021 BBP Public Option Public Comment12/8/2021 McAllister Public Testimony12/8/2021 Recording of Meeting