Connector Board Looks at CommCare Regs and FY11 Plan of Operations

The Connector Board met yesterday to discuss revised Commonwealth Care regulations and the Connector’s FY11 plan of operations.  Board Vice-Chair Dolores Mitchell chaired the meeting in Secretary Jay Gonzalez’s absence.

Materials from the meeting are here.

Glen Shor began the meeting with a quick report on the Connector’s activities:

  • Procurement: The Connector received RFR responses for Seal of Approval contracts, which are effective July 1, 2011.
  • Student Health Program Procurement: The SHP Steering Committee – of which the Connector is a key member – received bids for Academic Year 2011-2012.  They anticipate final selection of a plan(s) in March.
  • The commercial non-group insurance market is closed as of February 16.  The Connector website includes updates about the closed enrollment period as well as information for people whose circumstances may allow them to purchase insurance outside of the open enrollment period.
  • The Connector applied for and received an Early Innovators Grant for their proposal to create exchange IT infrastructure with UMass Medical School on behalf of a consortium of New England states.  Shor recognized Connector Chief Operating Officer Bob Nevins for his work on this grant.  The grant provides the Connector with resources to create reusable and transferable information technology related to exchanges, in order to help other states establish exchanges quickly and efficiently.  The Connector is working with UMass Medical School and the Blue Cross Blue Shield of MA Foundation on certain aspects of this initiative.
  • The Connector plans to reserve time at Board meetings to discuss Affordable Care Act implementation on a quarterly basis.

Commonwealth Care Regulations
Connector General Counsel Ed DeAngelo presented the Board with highlights of revisions to the Commonwealth Care regulations.

The changes are necessitated for primarily three reasons: to implement FY12 MCO procurement bidding rules; to accurately reflect current practice; and to strengthen the Connector’s program integrity measures.

CommCare MCO Procurement

  • Assignment of certain new and returning Plan Type I (below poverty) members to the lowest-cost plan.
  • Permits Connector to implement an active open enrollment for Plan Type I members, with assignment of Plan Type I members who do not actively choose a plan to the lowest cost plan.
  • Limits Plan Type I members’ ability to transfer from their assigned health plans.  Members will no longer have 60 days to switch their plan.

Clarify Current Practice

  • First month’s premium must be paid in full before enrollment.
  • Premium payment due date is the 25th of each month.
  • Members disenrolled for failure to pay premiums must pay their arrears before re-enrollment.

Program Integrity

  • Members are disenrolled if they owe two months of premiums.  Members get a warning after missing one payment along with an application for a hardship waiver and payment plan information.
  • Members on payment plans to pay back arrears must keep up with both the payment plan and the current monthly premium.
  • Members who have been out of CommCare for more than two years must pay their arrears before re-enrolling.

Nancy Turnbull requested information on how many members are disenrolled for failure to pay premiums, and how many members are on payment plans.  DeAngelo said the Connector staff will look into this.  In response to Celia Wcislo’s question, DeAngelo also noted that members can call the Connector’s customer service to talk about setting up a payment plan or applying for a hardship waiver.

The Connector also proposes two miscellaneous amendments to reflect the current economic climate:

  • Eliminate reference to the Fishing Partnership, which is being discontinued.  Previously, residents with access to the Fishing Partnership were ineligible for CommCare.  Income-eligible former Fishing Partnership members are being transitioned to CommCare (with the help of the HCFA HelpLine).
  • Premium and co-pay hardship waivers will also be available for members who have declared bankruptcy.

The Board voted unanimously to release the CommCare regulations for public comment, with a public hearing planned for April 5.  The Board will vote on the final regulations at the April 14 meeting.

FY2011 Plan of Operations Update
Connector COO Bob Nevins updated on the Connector’s progress in meeting their FY11 plan of operations goals.  According to Nevins, the Connector identified 49 key strategies across 4 planning categories: program, policy, administrative/organizational, and national health reform.  For the most part the Connector work is on schedule.

Turnbull requested that the Connector dig into data on the uninsured residents who earn less than 150% of the poverty level.  Shor responded that it may be possible to use the Health Insurance Responsibility Disclosure (HIRD) forms submitted by employers as well as Department of Revenue (DOR) matching data to get this information.  Turnbull requested that the Connector add a policy issue to their plan of operations – group purchasing cooperatives, which were established in Chapter 288 of the Acts of 2010.  Turnbull expressed that co-ops will have a negative effect on the rest of the market, including Commonwealth Choice.  Bob Nevins responded that there is a Connector subgroup that looks at Chapter 288 and discusses issues such as these.

Jon Gruber asked whether payment reform is on the agenda.  Shor responded that the Administration filed legislation guiding state health care programs towards alternative payment methods by 2014.  In the current CommCare MCO RFP, the MCOs are asked to collaborate on payment reform initiatives.

Wcislo asked about the Connector’s plans to more closely monitor access for CommCare members.  Shor said that the Connector is ramping up its oversight functions, and oversight is part of the MCO procurement process.  Connector staff will come back with more information on this in April.

The next Connector Board meeting is Thursday, March 10th from 9:00-11:00am at One Ashburton Place, 21st floor.
-Suzanne Curry

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One Response to Connector Board Looks at CommCare Regs and FY11 Plan of Operations

  1. Pingback: Connector Board Approves: Plans for CommChoice Seal of Approval; CommCare MCO Contracts; and Revised CommCare Eligibility Regulations |

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