State Marketplace Profiles: Rhode Island
Updated as of October 8, 2013
Establishing the Marketplace
After the legislature failed to pass Marketplace legislation during the 2011 session, Governor Lincoln Chafee (I) signed Executive Order 11-09 on September 19, 2011, to establish the Rhode Island Health Benefit Exchange.1 In July 2013, Rhode Island announced that its Marketplace would be called HealthSource RI.2
Recommendations by the Rhode Island Healthcare Reform Commission largely informed the Governor’s decision to issue an Executive Order. After SB 87 failed, the Commission regrouped to continue planning a State-based Marketplace.3 The Commission’s Executive Committee focused on evaluating non-legislative strategies to establish a Marketplace, while the Commission’s Health Insurance Exchange Workgroup began meeting biweekly to form recommendations on policy options to the Executive Committee.
Structure: The Executive Order establishes the Rhode Island Health Benefit Exchange as “a Division within the Executive Department.”
Governance: HealthSource RI is governed by a 13-member board. The Board includes four ex officio members (or their designees): the Director of the Department of Administration; the Health Insurance Commissioner; the Secretary of the Executive Office of Health and Human Services; and the Director of the Department of Health. The Governor appoints nine Board members, two of whom will represent consumer organizations and two to represent small businesses. The remaining appointees will provide demonstrated expertise in a diverse range of health care areas including, but not limited to, individual health care coverage, small employer health care coverage, health benefits plan administration, health care finance and accounting, administering a public or private health care delivery system, state employee health purchasing, electronic commerce, and promoting health and wellness. Board members cannot be affiliated with in any way, an insurer, a health insurance agent or broker, a health care provider, or a health care facility or clinic. No Board member can be a health care provider, unless no compensation is received for services rendered and the provider has no ownership interest in a professional health care practice.
The Board is required to receive guidance from an Expert Advisory Committee comprised of health industry experts, including representatives of insurers, agents and brokers, and providers. The Board also collects feedback from the Commission’s Health Insurance Exchange Workgroup, which allows for stakeholder participation and input on policy decisions.
Current appointed Board members are:
- Margaret Curran (Chair), former United States Attorney for Rhode Island
- Geoffrey E. Grove (Vice-Chair), Pilgrim Screw
- Michael C. Gerhardt, Save The Bay and former Health Insurance Executive
- Margaret Holland McDuff, Family Services of Rhode Island
- Peter Howland, retired Pediatrician
- Linda Katz, The Economic Progress Institute
- Marta Martinez, Progresso Latino
- Dwight McMillan, The Basics Group
- Patrick Quinn, SEIU, Healthcare 1199 New England
In June 2012, the Board hired an Executive Director to oversee all Marketplace activities. The Board has met regularly since October 2011 and receives feedback from the Commission’s Health Insurance Exchange Workgroup and the Expert Advisory Committee. Subcontractors have been solicited to provide technical assistance with business processes, stakeholder support, health plan certification, financial management and oversight, and commercial market activities to support the viability of HealthSource RI.45
Contracting with Plans: The Marketplace will function as an active purchaser that has “the discretion to determine whether health plans offered through the Exchange are in the interests of qualified individuals and qualified employers.” The Advisory Committee has explored Rhode Island’s options for risk adjustment and reinsurance, noting that legislation will be necessary in the future.6
HealthSource RI began direct negotiations with carriers in the fall of 2012. All four carriers in Rhode Island expressed interested in selling through HealthSource RI–Blue Cross Blue Shield of Rhode Island, Neighborhood Health Plan of Rhode Island and United Healthcare (SHOP only) filed to offer in 2014 and Tufts Health Plan intends to file for 2015. There are twelve plans offered through the individual market, including four Gold, four Silver, three Bronze, and one Catastrophic offering. Sixteen plans, including three Platinum, six Gold, five Silver, and two Bronze, are available on the small group market.7 In June 2013, the Office of the Health Insurance Commissioner approved final forms and rates for individual and small group plans submitted by carriers.8 The HealthSource RI Board announced final approval of QHPs for inclusion on the Marketplace in August.9 Rates may not differ by geographic area and are effective through December 31, 2014.10
QHPs offered through HealthSource RI will be subject to the same network adequacy standards, established by the Rhode Island Department of Health, that apply to all health plans offered in Rhode Island. These standards include geographic distribution and office hour requirements for primary care providers that go beyond the federal regulations for network adequacy. Network adequacy requirements will be reviewed annually, and the Executive Director of HealthSource RI may establish additional standards, if necessary.11
Dental and Vision Benefits: All plans sold through HealthSource RI must include the pediatric dental benefits covered under the pediatric dental EHB Benchmark plan (MetLife Federal Dental) and the pediatric vision benefits covered under the pediatric vision EHB Benchmark plan (FEP Blue Vision). Plans offered outside the Marketplace must also cover the pediatric dental services offered through the EHB Benchmark, unless the policyholder is already covered under a dental plan that offers those services.12
Consumer Assistance and Outreach: In July 2013, HealthSource RI and the Executive Office of Health and Human Services contracted with the Rhode Island Health Center Association (RIHCA)to develop and manage the state’s network of in-person assisters.13 RIHCA is responsible for training, certifying, managing, and compensating the network of assisters. In August 2013, RIHCA issued a Request for Proposals (RFP) to solicit a single organization to perform outreach and education activities and a separate RFP for entities to provide one-one-one enrollment assistance. In late September, RIHCA announced the organization selected to perform outreach and 11 community organizations chosen to carry out enrollment assistance activities. In-person enrollment assistance will also be available at each of the state’s eight federally qualified health centers (FQHCs), using federal funding awarded to support outreach and enrollment functions at FQHCs.14
In May 2013, the state selected a vendor to design and establish a consumer contact center,15 and the center opened in mid-September. In July, the Marketplace launched a consumer-facing website with a subsidy calculator and contracted with a firm to develop and produce a marketing campaign.16 The advertising campaign began on September 30, including print, television, radio, bus shelter, and billboard advertisements, and is intended to raise awareness of the Marketplace among all Rhode Islanders.17
In July 2013, Rhode Island launched the “39 in 3” campaign, through which HealthSource RI officials visited all 39 Rhode Island cities in three months to educate small employers, community organizations, and individuals about the health coverage options available to them through the Marketplace. In August 2013, Blue Cross Blue Shield of Rhode Island introduced their own education and outreach campaign by launching a website where Rhode Islanders can learn about the health reform law and establishing a partnership with Walgreens to distribute information to in-store and online customers.18
Small Business Health Options Program (SHOP) Marketplace: Small employers with up to 50 employees will be eligible to purchase coverage through the SHOP Marketplace. Employers purchasing coverage through HealthSource RI will either use the full employee choice model, through which employers will give their employees the choice to enroll in the SHOP plan that best meets their needs, or employers may select a single plan for all of their employees.19
HealthSource RI will certify licensed agents and brokers to assist small employers in purchasing coverage on the Marketplace. In order to participate on the Marketplace, producers must complete a training program, pass an examination, and receive notification of certification from HealthSource RI. The initial certification period is two years and will end on December 31, 2015. Producers will be compensated by issuers and will not receive any payment from HealthSource RI.20
Financing: The Executive Order authorizes the Marketplace to receive funds from insurers or other entities, including the United States Department of Health and Human Services, but it cannot use state general revenue funds. The Board will determine how the funds are to be received from insurers and the amounts.
Essential Health Benefits (EHB): The Affordable Care Act requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Marketplace, cover certain defined health benefits. States must decide whether to benchmark their EHB plan to one of ten plans operating in the state or default to the largest small-group plan in the state. In September 2012, the state recommended Blue Cross Blue Shield of Rhode Island- Vantage Blue PPO to serve as the benchmark plan.21
The Rhode Island Department of Business Regulation received a federal Exchange Planning grant of $1 million in 2010 and was awarded a $5.2 million federal Level One Exchange Establishment grant in May 2011 to “strengthen health information technology systems, develop an integrated consumer support program to provide support to individuals and small businesses, and strengthen its business operations.” In addition, Rhode Island is a member of the consortium of New England states that received a federal Early Innovator grant of $44 million to develop, share, and leverage Marketplace technology. The multi-state consortium also includes Connecticut, Maine, Vermont, and Massachusetts with the University of Massachusetts Medical School as the grant holder. In November 2011, Rhode Island received the first Level Two Exchange Establishment grant. The $58.5 million grant will fund the development, design, and technology procurement of HealthSource RI through December 2014.22
Rhode Island, along with nine other states, is receiving technical assistance from the Robert Wood Johnson Foundation through the State Health Reform Assistance Network; this assistance includes help with setting up health insurance Marketplaces, expanding Medicaid to newly eligible populations, streamlining eligibility and enrollment systems, instituting insurance market reforms and using data to drive decisions.23
On December 20, 2012, Rhode Island received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a State-based Marketplace.24 The HealthSource RI Marketplace portal became operational on October 1 and began enrolling qualified individuals, families, and small businesses into coverage.
Additional information about HealthSource RI can be found at: http://www.healthsourceri.com/
Executive Order 11-09. Establishment of the Rhode Island Health Benefits Exchange.
SB87. Rhode Island’s bill to establish a health benefit exchange in 2011.
Rhode Island Level One Establishment grant application. Funding Opportunity IE- HBE-11-004.
Risk Adjustment and Reinsurance. Rhode Island Health Benefits Exchange Expert Advisory Committee. November 22, 2011.
Rhode Island Health Benefits Exchange. Update on Qualified Health Plan Filings: Advisory Board Briefing. May 15, 2013.
Office of the Health Insurance Commissioner. “OHIC Approves Commercial Health Insurance Contracts, Rates and Rate Factors." June 28, 2013.
“HealthSource RI Announces Approved Plans and Rates.” August 21, 2013.
Office of the Health Insurance Commissioner Regulation 17- Filing and Review of Health Insurance Plan Forms and Rates.
Letter from Michael Fine, Department of Health, to Christopher Koller, Health Insurance Commissioner, and Christine Ferguson, Director RI Health Benefits Exchange. January 11, 2013.
Checklist for Individual and Small Group Health Insurance Plans- Policy Form.
Request for Proposals: Rhode Island Outreach and Enrollment Support Program (OESP): Network Manager. May 2, 2013.
“Community organizations to help explan new health insurance options.” September 24, 2013.
Request for Proposals: Rhode Island Health Insurance Contact Center. March 20, 2013.
HealthSource RI. Communications Plan Launch Messaging & Activities July-August. July 16, 2013.
“Ad campaign uses R.I.’s pioneering past to spur interest in health exchange.” September 30, 2013.
“Blue Cross launches health reform education campaign.” August 14, 2013.
HealthSource RI. Plans and Rates for HealthSource RI 2014. August 20, 2013.
HealthSource RI. HealthSource RI Small Business Health Options Program Agent/Broker Agreement. October 2013.
Office of the Health Insurance Commissioner. Benchmark Plan selection.
Robert Wood Johnson Foundation. ‘RWJF Seeks Coverage of 95 Percent of All Americans by 2020.’ May 6, 2011.
Letter from Governor Chafee to Kathleen Sebelius. July 5, 2012.
also of interest
- The Wisconsin Health Care Landscape
- Renewals in Medicaid and CHIP: Implementation of Streamlined ACA Policies and the Potential Role of Managed Care Plans
- Analysis of 2015 Premium Changes in the Affordable Care Act's Health Insurance Marketplaces
- How Will the Uninsured in Rhode Island Fare Under the Affordable Care Act?