Federally Facilitated Exchanges and Application Interfaces€¦ · • Purpose: Provide walkthrough of API design, and receive technical comments from industry experts • Background

Web-Broker API: Technical Validation Session

Federally Facilitated Exchanges and Application Interfaces An Overview for Discussion Purposes

25 January 2013

Overview

• Presenters today: – Peter Nakahata and Andrew Rumin – CCIIO, CMS

– Mark Oh – OIS, CMS

• Purpose: Provide walkthrough of API design, and receive technical comments from industry experts

• Background and context for the web-broker API

• Overview solution approach

• Consumer workflow

• Key Interaction Scenarios

• Receive feedback and answer questions

2

3

Background

• Consumers can shop for Health Insurance on the FFE, or on a

Web-Broker or Issuer’s website

• To extent permitted by a state, HHS intends to work with web-

brokers that meet applicable requirements to help consumers

select QHPs online.

• API allows for consumer to approach web-broker website and:

• receive an eligibility determination from FFE;

• select QHP on the web-broker’s website; and

• enroll in a QHP through the FFE.

Background – Federal Rules (45 CFR 155.220)

• Like other agents/brokers, web-brokers must be registered with FFE, receive training, be licensed and execute an agreement with HHS.

• Web-broker specific requirements: – Meet all standard for disclosure/display of QHP information;

– Provide consumers the ability to view all QHPs offered through the Exchange;

– Not provide financial incentives (e.g. rebates/giveaways);

– Display all QHP data provided by Exchange;

– Maintain audit trails for 10 years minimum;

– Provide consumers with ability to withdraw and use Exchange website.

• CMS will likely specify additional expectations.

5

Solution Approach

• FFE will expose its business services to Partner Websites for Eligibility

determination, Searching and comparing QHPs, Enrollment, Disenrollment and

reporting changes

• Eligibility determination for financial assistance requires access to FTI. IRS

regulations prohibit access to FTI from Web Broker/ Issuer systems.

• Consumer will be routed to the FFE website for collecting personal and

financial information (Cannot use a web service since Partner Websites are not

allowed collect or display FTI)

• FFE will also capture pre-enrollment attestations directly from the consumer

• Given the above, the FFE API will include HTTP redirects and web services

• Account creation, Application submission, Eligibility determination and

attestations would be performed on the FFE via HTTP redirect

• QHP shopping, enrollment, enrollment changes and disenrollment would be

performed through web services

• All web services will be exposed through the Data Services Hub

6

Consumer Workflow

User Accesses PartnerWebsite

User Registers with Partner Website

User Decides toShop for QHP?

User Continues Shopping on

Partner Website

User Redirected to Landing Page of FFE

User Creates Account on FFE

User SubmitsFFE

Application

FFE TransfersAccount To State

Agency for Eligible Applicant

Partner WebsiteRetrieves Eligibility

Information

FFE Notifies User on Eligibility and

Account Transfer

Partner Website Stops Processing Applicant

FFE Notifies UserOn APTC/CSR

Eligibility

User Shops for QHPs/

Submits Enrollment

FFE Website

Partner Website

Popup #1

FFE EligibilityDetermination


Information

User completes Enrollment

Attestations

Popup #2


Information

User Continues Shopping on

Partner Website for Applicant

Partner Website calling FFE Web service

FFE Notifies UserOn Applicant

Ineligibility for QHP

Legend

Partner WebsiteCollects Initial Premium

Applicants Not Eligible for

QHP

Applicants Eligible for Medicaid/CHIP

Applicants Eligible for QHP

Yes

No

Key Interaction Scenarios

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Scenario # Scenario Title

1 New QHP Enrollment (with or without financial assistance)

2 Consumer returns to continue shopping

3 Consumer reports changes impacting eligibility

4 Consumer reports changes not impacting eligibility

5 Consumer reports changes resulting in Disenrollment

6 FFE Initiated Disenrollment

7 Voluntary Disenrollment by consumer

Interaction Scenario #1 – New Consumer

8

New QHP Enrollment (with or without financial assistance)

Register on Broker/ Issuer

Website

EnterDemographics

EligibilityDetermination

Flow

RegisterWith Exchange

Plan Compare

FetchPlan List, Details,

Comparison


Comparison

Plan Select/Submit

Enrollment

ProcessEnrollment

ProcessEnrollment

RIDP

XML

Individual

Federally Facilitated Exchange

Issuer/ Broker Plan Shopping Site

Redirect/ Popup

Redirect/ Popup

CollectInitial

Premium

Redirect/Return

Collect Initial Premium(Issuer’s

Payment Portal)Retrieve

Household/ Eligibility Details

RetrieveHousehold/ Eligibility

Details

FetchHousehold/Eligibility

Details


Details

XMLXML

Send x12-834 To Issuer

Select QHP(s);Compose Coverage Household;Submit Enrollment

EnrollmentAttestations

AcceptEnrollment

AcceptEnrollment

Redirect/Return

Interaction Scenario #2 – Returning Customer

9 Consumer returns to continue shopping

Login To Broker/ Issuer

Website

EligibilityDetermination

Flow

LoginTo Exchange

Plan Compare


Comparison


Comparison

Plan Select/Submit

Enrollment

ProcessEnrollment

ProcessEnrollment

XML

Individual



Redirect/ Popup

CollectInitial

Premium

Redirect/Return

Collect Initial Premium(Issuer’s

Payment Portal)Retrieve

Household/ Eligibility Details


Details


Details


Details

XMLXML


Continue from previously completed step

Select QHP(s);Compose Coverage Household;Submit Enrollment


AcceptEnrollment

AcceptEnrollment

Redirect/Return

Interaction Scenario #3 – Changes (1)

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Consumer reports changes impacting eligibility • Income, Addition or removal of household members

Login toBroker/ Issuer

Website

InitiateMid-Year Change

EligibilityDeterminationFlow (Changes)

Login to FFE

Plan Compare


Comparison


Comparison

Plan Select/Submit

Changes

AcceptEnrollment

Changes

AcceptEnrollment

Changes

XML

Individual



Redirect/ Popup

Redirect/Return


Details


Details


Details


Details

XMLXMLRedirect/Popup


Select QHP(s);Compose/ Change Coverage Household;Submit Enrollment

ProcessEnrollment

Changes

ProcessEnrollment

Changes



11

Consumer reports changes not impacting eligibility • Demographic changes, Income (if within same eligibility range)


Website



Login to FFE

Process Enrollment

Update

Process Enrollment

Update

Individual



Redirect/ Popup

Redirect/Return


Details


Details


Details


Details

XML


No change in eligibility


12

Consumer reports changes leading to Disenrollment • Eligible for Medicaid/CHIP, Lost eligibility for QHP, Lost eligibility for APTC/CSR




Login to FFE

ProcessDisenrollment


Individual



Redirect/ Popup

SubmitDisenrollment

Redirect/Return


Details


Details


Details


Details

XMLXML


Interaction Scenario #6 – Disenrollment (1)

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FFE Initiated Disenrollment


Website



Individual



SubmitDisenrollment

XML


InitiateDisenrollment

Periodic Data Match/ Expired Inconsistency

Periodic Data Match/ Expired Inconsistency

Notice on Loss of APTC/CSR and option to Dis-enroll

Interaction Scenario #7 – Disenrollment (2)

14

Voluntary Disenrollment by Consumer


Website



Individual



SubmitDisenrollment

XML


InitiateDisenrollment

Interfaces

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Interface Description

Transfer Consumer to FFE for Account Creation and Eligibility Determination

This HTTP redirect interface will transfer the consumer from the Partner Website to the FFE for account creation and eligibility determination. This will establish a link between the consumer’s accounts on the Partner Website and the FFE.

Transfer Consumer back to Web Broker/Issuer

This HTTP redirect interface will transfer the consumer from the FFE to the Partner website after completion of the eligibility determination process. This interface will also be used in other situations such as on the consumer’s intent to return or exceptions such as failure to create an FFE account due to failure in RIDP. The FFE will transfer the consumer to the Return URL provided by the partner website while transferring the consumer to the FFE.

Transfer Consumer to FFE to Continue Application

This HTTP redirect interface will transfer a returning consumer from the Partner website to the FFE. In this case the consumer would have already created accounts on the Partner website and the FFE and the link would have been established. The consumer will continue from the last step they were at during the previous session.

Transfer Consumer to FFE for Enrollment Attestations

This HTTP redirect interface will transfer the consumer from the Partner website to the FFE to collect pre-enrollment attestations.

Interfaces (Contd.)

16


Fetch Household/ Eligibility Details

This FFE Web service will return details of all members in household requesting coverage along with their eligibility for financial assistance. Eligibility information returned will include Medicaid/CHIP eligibility and eligibility for APTC/CSR. Demographic information for the members required for enrollment will also be included.

Fetch List of QHPs This FFE web service will return a list of QHPs that match the search criteria specified by the consumer on the Partner website. Search criteria could include household composition, premium cost range and any special health coverage requirements.

Fetch QHP Details This FFE web service will return detailed plan information for a QHP selected by the consumer on the Partner web site.

Fetch Side by Side Compare of QHPs

This FFE web service will return a tabulated response with a side by side comparison of a list of selected QHPs on a variety of factors such as cost, coverage area and benefits.

Interfaces (Contd.)

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Submit Enrollment This FFE web service will process an enrollment request from the Partner website. The information included in this request will be used for sending the 834 enrollment transaction to the issuer.

Submit Enrollment Change This FFE web service will process an enrollment change request from the Partner website. Enrollment change requests include:

Adding or Removing a member

Changing QHPs

Change in eligibility status

The information included in this request will be used for sending the 834 enrollment change transaction to the issuer.

Submit Disenrollment This FFE web service will process a disenrollment request from the Partner website. The partner website will invoke this service for FFE initiated dis-enrollments, Consumer reported changes resulting in dis-enrollments and voluntary dis-enrollments by the consumer

The information included in this request will be used for sending the 834 dis-enrollment transaction to the issuer.

Questions and Comments

• Questions/comments and open discussion from industry experts

Federally Facilitated Exchanges and Application Interfaces€¦ · • Purpose: Provide walkthrough of API design, and receive technical comments from industry experts • Background

Documents