Connector Board Report 11/10/10

The Connector Board met today to discuss Commonwealth Choice Seal of Approval, the small business wellness subsidy, and FY12 Commonwealth Care MCO procurement.

Secretary Jay Gonzalez took a moment at the beginning of the meeting to celebrate the outcome of the gubernatorial election, and the amazing success of all involved stakeholders in implementing Massachusetts health reform.

Gonzalez also noted significant challenges to sustaining health reform’s success, including cost control, national health reform implementation, and budget constraints. With optimism, Gonzalez stated that “if all stakeholders are involved in the cost control solution like the first phase of health reform, we will succeed.”

You can see the materials from the meeting on the Connector site, and read on for our full report.

Next, Connector Executive Director Glen Shor reviewed the November 1st enrollment numbers:

  • Commonwealth Care: 154,711 (+700 members from Oct)
  • Commonwealth Care Bridge: 22,775
  • Commonwealth Choice: 41,112 (+150 members)

Shor also announced that the Board retreat is scheduled for December 4th; the focus of the meeting is national health reform implementation.

CommChoice Seal of Approval
Roni Mansur, Kaitlyn Kenney, and Ed D’Angelo gave a short presentation on Commonwealth Choice Seal of Approval, which the Connector awards to plans that meet their standards for quality and value.

According to Mansur, the Connector is currently requesting a six-month contract with carriers for the period of January 1-June 30, 2011, and plans to issue an RFR in January 2011 for CommChoice participation beginning July 1, 2011. This allows the Connector to keep CommChoice “as is” while making updates and enhancements in the program. Many of these enhancements are meant to facilitate all carriers’ participation in Business Express, the small business coverage program.

In advance of the next fiscal year, the Connector plans to conduct focus groups to help inform the right balance of CommChoice plan design options. Nancy Turnbull requested that the Connector also provide the Board with CommChoice premium trends over time by carrier and product.

With that, Gonzalez called for a vote. Rick Lord recused himself due to a potential conflict of interest. The remaining Board members voted to approve the seven incumbent CommChoice carriers for the period of January 1-June 30, 2011:

  • Blue Cross Blue Shield of Massachusetts
  • CeltiCare Health Plan
  • Fallon Community Health Plan
  • Harvard Pilgrim Health Care
  • Health New England
  • Neighborhood Health Plan
  • Tufts Health Plan

Small Business Wellness Subsidy
Bob Nevins and Scott Devonshire gave an overview of the small business wellness subsidy. Chapter 288 of the Acts of 2010 gives the Connector authority to issue state-funded subsidies to small businesses for providing a wellness program for their employees.

To qualify for the wellness program, employers must:

  • Purchase coverage through the Connector
  • Have fewer than 25 full time equivalent employees
  • Have an average employee salary less than $50,000/year
  • Contribute at least 50% to their employees’ premiums
  • Offer a wellness program that meets certain criteria, with a minimum employee participation requirement

In turn, the Connector is responsible for:

  • Offering wellness subsidies: 5% of annual employer health care costs
  • Defining minimum criteria and participation
  • Assisting in grant writing to maximize federal funding
  • Promulgating regulations
  • Submitting annual reports to the Legislature
  • Easing small businesses’ administrative burden

The Connector is working diligently to iron out the details of the wellness program; implementation begins July 1st.

FY12 CommCare MCO Procurement
Connector CFO Jean Yang presented the Connector’s plans for the FY12 Commonwealth Care MCO procurement process.

According to Yang, procurement challenges include:

  • State budget constraints
  • Potential fiscal impact of the Finch case: This is the class action lawsuit filed by Health Law Advocates contesting disenrollment of “special status” legal immigrants from CommCare. A ruling in favor of the plaintiff would allow this population to re-enroll in CommCare.
  • Uncertainty in enrollment: CommCare enrollment will potentially increase as people’s unemployment insurance extensions run out and their Medical Security Program (MSP) coverage ends. There are currently 40,000 MSP members, thousands of whom may fall off coverage soon.

The Connector is working off the assumption that the current CommCare population will remain in place in FY12. That is, CommCare members with incomes below 133% fpl will remain in CommCare and not transition to MassHealth. The Affordable Care Act gives states the option to include this population in Medicaid as of April 2010. According to Yang, EOHHS has established a workgroup to collect and analyze facts and figures to inform their decision of when and how to make this transition.

In addition, the Connector is in the process of analyzing and considering use of the following in the FY12 CommCare MCO procurement:

  • Utilization and care management
  • Limited networks
  • Eliminating co-pays for preventive services
  • Premium structure, in coordination with the Affordability Schedule
  • Premium spread between low and high cost plans
  • Risk adjustment
  • MCO administrative costs
  • Program integrity

The Connector plans to issue the CommCare RFP in February and ask for a Board vote on MCO contracts in April.

The next Connector Board meeting is on Thursday, December 9th from 9-11 am at One Ashburton Place, 21st floor, Boston.
-Suzanne Curry

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