The Connector Board met last week to discuss their upcoming Seal of Approval RFR for Commonwealth Choice plans, Young Adult Plans (YAPs), and approval of a contract extension for their communications firm, Weber Shandwick (see the materials here).
The bulk of the meeting focused on changes to the Seal of Approval for CommChoice.
The next contracts will be for 18 months to ease the burden on both carriers and the Connector. The biggest contractual changes are that carriers will be required to participate in both CommChoice and Business Express. Carriers will be allowed to offer limited networks, but they must also provide full network plans in each tier in which they participate. Based on new focus group testing (done in December 2010) and conversations with the carriers, the Connector will make some changes to the benefit specifications. The medium rung of the Silver package will be eliminated. Additionally, certain service categories (Inpatient SNF, Office visit for outpatient mental health, Routine vision, Ambulance) will be removed from the standardized specifications, which will allow the carriers to modify the cost-sharing for these products. The Connector will review the coverage and cost-sharing for all of these services as part of the Seal of Approval process. The final change to the Seal of Approval process is that the Connector is removing the $10 PSPM administrative fee charged under Business Express for small groups of 1-5 as of July 2011. Business Express will also include a wellness program component that is currently under development.
After significant discussion, the Connector approved a new RFR. The discussion around the Seal of Approval came from Dolores Mitchell, Celia Wcislo, Nancy Turnbull, and Lou Malzone who expressed concern that the changes in the benefit standardization will make the plans more complicated and allow for adverse selection. None of these members held up the release of the RFR, but wanted to make sure that their concerns were noted as the trade-off did not appear equal – the carriers seemed to gain with these changes.
A quick update on the YAP plans included a preview of the decisions that need to be made over the next year: the Connector needs to determine if they will ask for another waiver from the annual and lifetime cap requirement under the Affordable Care Act for renewals and whether they will add in a High-Deductible Health Plan product to the YAP portfolio. In order to make these decisions, they are going to seek information from the carriers about the YAP expenses including how many hit the caps and the costs to remove the caps.
The meeting also included a quick update on the Student Health Plan RFR. This went out on January 14th and includes coverage for about 30,000 students from the Community Colleges and UMass campuses.