Cascade Care Implementation

Public Comment

The Exchange is seeking public comment on two separate aspects of Cascade Care implementation: the State Premium Assistance for Cascade Care Draft Policy and Draft 2023 Standard Plans. Please find more information below. 

State Premium Assistance for Cascade Care Draft Policy

During the 2021 legislative session, the Washington State Legislature passed Senate Bill 5377 which directed the Exchange to establish a state premium assistance program for Washington residents. In the 2021 State Operating Budget, funding was provided to extend premium assistance to Washington residents earning up to 250% of the federal poverty level, beginning in 2023.

On October 13, 2021, Washington Health Benefit Exchange (Exchange) held a public webinar to walk stakeholders through the preliminary draft of the State Premium Assistance policy and answer questions. You can view a recording of the webinar here. You can also find an illustrative example of calculating the state subsidy here.

The public comment period runs through November 12. Comments can be sent to [email protected].

Additional opportunities for stakeholder engagement will be available prior to the Exchange finalizing the policy. Pease subscribe to receive emails with information about updates to this page, upcoming meetings, stakeholder input opportunities, and other relevant announcements.

Draft 2023 Standard Plans 

Standard Plans are offered in every county in Washington. Every carrier on the Exchange is required to offer at least one standard silver plan and one standard gold plan in every county in which they offer coverage. Carriers that offer bronze plans on the Exchange are also required to offer a standard bronze plan.  

The Exchange is preparing the Standard Plan designs for plan year 2023 to be offered on Washington Healthplanfinder, and is seeking public comment on one bronze, one silver, and one gold standard plan, as well as three cost-sharing variants of the standard silver plan, that are being proposed for 2023. You can find the draft 2023 Standard Plans here. Materials from the October 21, 2021, presentation to the Exchange Board on the proposed 2023 Standard Plans are located here.   

The public comment period is open from October 25 – November 23. Comments can be sent to [email protected]. The Exchange welcomes all feedback on the proposed plans, and also seeks comment on the following specific questions:  

  1. Do the proposed plans strike the right balance with the blend of cost-sharing (deductibles, out of pocket maximums, and copays) utilized at each metal level? 

  2. The proposed plans standardize three additional benefits in their plan designs: durable medical equipment (DME), hospice, and home health benefits. The proposed plans all include a co-insurance for DME and co-pays before the deductible for hospice and home health benefits. The copays for hospice and home health in the proposed plans are set at the same amount as the primary care copay in each of the plans. Please provide feedback on the standardization of these three additional benefits and the appropriateness of co-insurance or co-pay applied to each benefit.  

  3. Please provide feedback on the potential premium impacts of standardization of the three additional benefits, identified by Wakely and included in the October 21, 2021, Exchange Board presentation.  

  4. Are there any technical issues (e.g., mental health parity compliance) with standardizing these benefits that the Exchange should consider? Do any aspects of the plan designs present technical challenges to the plan filing process that the Exchange should be aware of? 

About Implementation

Washington Health Benefit Exchange implemented Senate Bill 5526 (Cascade Care), in partnership with the Health Care Authority and the Office of the Insurance Commissioner.

Cascade Care created new coverage options (standard plans and public option plans) that became available through Washington Healthplanfinder during Open Enrollment on November 1, 2020 for coverage effective January 1, 2021. Cascade Care implementation includes:

  1. Standard Plans: The Exchange annually develops standard plan designs by working with a wide variety of implementation partners – including Standard Plan Workgroup members and actuaries from Wakely Consulting Group. Standard plans, which are qualified health plans that have a standard benefit design across carriers, will be more understandable, more affordable, and of more value for Washington Healthplanfinder customers.
  2. Public Option Plans: The Health Care Authority, in consultation with the Exchange and other implementation partners, procures public option plans that are available through Washington Healthplanfinder. Public option plans are qualified health plans that have a standard benefit design and meet additional quality and value requirements.
  3. Subsidy Study (premium wrap): The Exchange developed and submitted a plan for implementing state premium subsidies for Washington Healthplanfinder consumers with income up to 500% Federal Poverty Level (FPL) in December of 2020. The actuarial analysis and corresponding cover memo assisted in 2021 legislative deliberations that led to the enactment of a Washington State Premium Assistance Program. This program, effective beginning January 2023, will provide state funded premium assistance to Washington Healthplanfinder enrollees earning under 250% FPL.
  4. State Premium Assistance: The Exchange was directed to establish a state premium assistance program, and $50 million of state funds were appropriated to support the implementation of this program for plan year 2023. The program will provide state premium assistance to Washington residents earning under 250% FPL who enroll in Silver or Gold standard plans, including public option plans, through the Exchange.

This page will be regularly updated with the information about the implementation of Cascade Care. If you are interested in following this work, please subscribe to receive emails with information about updates to this page, upcoming meetings, stakeholder input opportunities, and other relevant announcements. 

Additional Information

Learn more about:

What is Cascade Care?

Cascade Care legislation, Senate Bill 5526, was passed by the Washington state legislature in 2019. The bill creates new standard plans and public option plans that will be offered through Washington Healthplanfinder for Washingtonians, and directs the Exchange to develop a state premium subsidy implementation plan.  

These new plan options are expected to improve the stability and affordability of the individual market and provide better value for Exchange consumers. Standard plans and public option plans will be offered exclusively through Washington Healthplanfinder during open enrollment starting November 1, 2020 for coverage beginning January 1, 2021. 

 

What are the main components Cascade Care

There are 3 main components:

  1. Standard Plans: The Exchange has developed standard plan designs.  Standard plans, which are qualified health plans that have a standard benefit design across carriers, will be more understandable, more affordable, and of more value for Washington Healthplanfinder
  2. Public option plans: The Health Care Authority will be working to procure public option plans that will be available to Washington Healthplanfinder.  Public option plans are qualified health plans that have a standard benefit design and meet additional quality and value requirements.
  3. Subsidy Study (premium wrap): The Exchange will be developing and submitting a plan for implementing state premium subsidies for Washington Healthplanfinder consumers with income up to 500% Federal Poverty Level (FPL). This report is due to the legislature November 15, 2020.
 
  What are standard plans?

Standard plans will be a type of qualified health plan offered by insurance carriers on the Exchange. These plans will have a standard cost-sharing design, meaning they have the same deductible, co-pays, and co-insurance for medical services, and offer the same services before the deductible, no matter which carrier is offering it. As a result, consumers can more easily and accurately compare plans based on premium price, provider networks, customer service, and quality. Standard plans are also expected to:

  • Lower deductibles
  • Improve access to pre-deductible, evidenced-based services across insurers
  • Provide transparent, predictable cost-sharing

Increase the value of the federal premium subsidies   

 

What are public option plans?

Standard plans and public option plans will have the same standard benefit design across insurance carriers. Public option plans will be unique in that the provider reimbursement is tied to Medicare rates that should lower their premiums. These plans also must meet additional quality and value requirements.   

 

When will new standard plans and public option plans be available to consumers?

Standard plans and public option plans will be offered exclusively through Washington Healthplanfinder during open enrollment starting November 1, 2020 for coverage beginning January 1, 2021.   

 

How will the Exchange help consumers understand the new Cascade Care plan options? 

The Exchange is developing tools and outreach materials for consumers that will help them select the best plan from among their available options, based on factors that are important to them - such as overall cost, provider access, and prescription drug needs. These tools and outreach materials will be informed by consumer testing and input from Exchange workgroups and committees.

 

How is the Washington Health Benefit Exchange, Office of Insurance Commissioner and Health Care Authority coordinating to implement Cascade Care?

Washington Health Benefit Exchange, Health Care Authority, and Office of Insurance Commissioner are working very closely together on all aspects of implementation of Cascade Care. An inter-agency workgroup meets every two weeks to coordinate work streams, which are outlined in this timeline.   

 

How can I stay updated about and participate in Cascade Care implementation?

If you are interested in following this work, please subscribe to receive emails with information about updates to this page, upcoming meetings, stakeholder input opportunities, and other relevant announcements. The Exchange conducted a formal comment period during Fall 2019 on standard plans. Feedback from all interested stakeholders on the draft standard plan designs was solicited.

Cascade Care Workgroup 

The Cascade Care Workgroup, which represents a broad spectrum of stakeholder perspectives, is working with the Exchange to implement Cascade Care. This group has regular open-public meetings during which policy and  design considerations are discussed.

 

Plan Certification Workgroup 

The Plan Certification Workgroup, which is comprised of Washington’s health and dental insurers, routinely meets to provide technical feedback to the Exchange. This group of will provide technical feedback on standard plans throughout the design process.

 

Exchange Board Meetings 

The Exchange Board has open-public meetings every other month. High-level updates on Cascade Care implementation will be routinely provided. Standard plans designs will be presented to the Exchange Board for their review and approval in December 2019.

 

Public Comment 

The Exchange is conducting a formal public comment period on the 2022 draft standard plan designs that will run from November 30, 2020 through December 29, 2020. Feedback from all interested stakeholders on the draft standard plan designs will be solicited. For more information and to submit public comment, see Cascade Care Standard Plan Public Comment.

Cascade Care Launch (PDF)

For more information on the Exchange’s Cascade Care implementation work please contact Cascade Care Workgroup at [email protected]