Connector Board Report – May 10, 2012

Today, the Connector Board met to discuss the 2013 Commonwealth Choice Seal of Approval and the Exchange Project Management contract.

Materials from the meeting are posted here and our full report is after the fold.

Glen Shor began the meeting with the Connector’s program enrollment numbers as of Enrollment as of May 1, 2012:

  • Commonwealth Care: 184,281 (increase of over 9,000 people, mainly due to the transition of legal immigrants from the Health Safety Net to Commonwealth Care).
  • Commonwealth Choice: 39.382 (a slight decrease from April, largely attributable to payment activity).

In addition, the Connector is preparing for both Commonwealth Care and Commonwealth Choice open enrollment, which is June 1-22 and July 1-August 15 respectively.  On the Commonwealth Choice side, the Connector is working to make it easier for consumer to enroll in and switch plans through their website.  Letters will be mailed out in subscribers’ invoices beginning this week, and the Connector has staffed up their call center.

The Connector is also continuing their Affordable Care Act (ACA) implementation work.  This past week, staff from the Connector, EOHHS, and MassHealth met with representatives from CMS, CCIIO and the IRS to discuss Massachusetts’ progress in transitioning to the ACA.  The Connector also met with staff from Rhode Island and Vermont for a tri-state IT session.  Last but not least, on Wednesday the Massachusetts House of Representatives passed an FY12 supplemental budget that included language authorizing the Connector as the Commonwealth’s ACA-compliant exchange.  The Connector expects the Senate to take up this bill today.

Commonwealth Choice 2013 Seal of Approval

Roni Mansur (Chief Operating Officer) and Sarah Stephany (Program Coordinator) presented the Connector staff’s 2013 Seal of Approval recommendation.  The Connector puts their Seal of Approval on plans that meet their standards for quality and value.

The current Commonwealth Choice Seal of Approval contracts run from July 1, 2011 through December 31, 2012.  During this time, the Connector:

  • Achieved full health insurance carrier participation in the Connector’s small business program through re-launch of Business Express;
  • Added a new carrier, BMC HealthNet Plan;
  • Implemented Wellness Track;
  • Launched a provider search tool on their website;
  • Implemented Chapter 288 provisions, including non-group open enrollment; and
  • Removed the annual benefit maximum for all new sales of Young Adult Plans (per the ACA).

The Connector’s main goal in 2013 is to keep pace with health benefit design changes in the private health insurance market while continuing to offer small businesses and individuals plans that meet their needs and avoiding significant operational disruptions while the Connector plans for changes required by the ACA.

Therefore, the Connector recommends:

  • Extending current carrier contracts for an additional 12 months beginning January 1, 2013 through December 31, 2013, and
  • Issuing a Request for Responses (RFR) for new carriers for the term beginning January 1, 2013 through December 31, 2013.

Carriers must continue to meet current Seal of Approval requirements by participating in all product offerings (small and non-group) and providing products that meet the current standardized plan designs in all benefits tiers on the broadest commercial provider network offered.

In addition to offering standardized products, the Connector is inviting carriers to offer one or more of the following effective January 1, 2013:

  • Narrower network products on all standardized plans designs for at least one benefit tier (Gold, Silver, or Bronze) and/or
  • One or more other popular/innovative products (i.e. do not need to meet standardization) – this could include tiered networks.

According to Shor, the Connector is proposing this strategy in response to market changes, feedback from small businesses, with the overall goal of adding value to the Commonwealth Choice product “shelf.”

All proposed products will be subject to the Connector’s review and approval based on criteria including but not limited to:

  • Meeting MCC standards;
  • Including federal and state mandated benefits;
  • Bringing value to consumers; and
  • Achieving premiums cost savings for consumers.

Depending on what new products are proposed and subsequently approved, the Connector may need to introduce a new tier or benefit package.  According to Shor, the Connector will issue broad guidance to carriers on what criteria the Connector will use to evaluate new products and will work closely with the Board to assess proposals to promote clarity and comprehensiveness.

Jon Gruber commented that if the Connector moves away from standardization, they “need to provide more cutting edge decision support for consumers.”  Celia Wcislo commented that the Connector needs to not just look at premium costs but all costs consumers pay and ask “What are the costs being transferred to consumers?”

Lou Malzone remarked that the Connector should not make buying insurance more complicated than it already is.  He said, “[The Connector’s offerings] should not be equal to the entire insurance market that has thousands of products that no one understands.  If we don’t do something about this complexity soon, we will be on a path to unsustainable health care costs.”

The Connector will notify existing carriers of their intent to extent the contract within the next week.  Then, they will issue an RFR, hold a bidders conference, and review proposals, with the intent to present recommendations to the Board in August or September.

National Health Care Reform Transition Planning: Continuation of Project Management Assistance

Roni Mansur and Ed DeAngelo (General Counsel) presented the Board with the Connector’s recommendation to extend the Connector’s contract with Deloitte for project management support around ACA planning and transition.

In addition to day-to-day support, analysis, and strategy, Deloitte will help the Connector with a new focus of coordinate robust engagement of external stakeholders on major policy and operational decisions.  The Board voted to extend Deloitte’s contract through June 30, 2013.
-Suzanne Curry

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