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The Federally Facilitated Marketplace is established in a state by the HHS Secretary for states that chose not to set up their own marketplace or did not get approval for one. [2] Individuals (i.e. citizens of a state) and employers will have the ability to find and purchase Qualified Health Plans through the FFM and its partners. [1]
Implementation of the individual exchanges changed the practice of insuring individuals. The expansion of this market was a major focus of ACA. [21] Over 1.3 million people had selected plans for 2015 marketplace coverage in the first three weeks of the year's open enrollment period, including people who renewed their coverage and new customers ...
Prior to certification and training, the Centers for Medicare and Medicaid Services (CMS) require that all navigator and non-navigator individuals or entities seeking to facilitate public enrollment in plans disclose information that may result in a conflict of interest to exchanges and consumers. [2]
Specifically, most ratings are determined from multivariate logistic regressions of medical outcomes at a given healthcare provider to risk-adjust the patients and 1-, 3- and 5-star awards are given to providers whose negative outcomes are worse than expected, near predicted levels, and better than expected, respectively.
Molina Healthcare was founded in 1980 by C. David Molina, an emergency room physician in Long Beach, California. [4] He had seen an influx of patients using the emergency room for common illnesses such as a sore throat or the flu because they were being turned away by doctors who would not accept Medi-Cal.
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