Connector Previews “Home Stretch” of ACA Implementation

Last Thursday, the Connector Board discussed policy, programmatic and operational readiness for Connector 2.0, voted to extend their Affordable Care Act (ACA) project management contract with Deloitte, and approved the transfer of authority over several regulations from CHIA to the Health Connector, as required by Chapter 224.

Materials from the meeting are here and our full report is a click away:

Jean Yang started the meeting with her Executive Director’s report:

  • Program Enrollment: As of May 1st, Commonwealth Care enrollment is 206, 911, the program’s highest enrollment to date.  Commonwealth Choice enrollment remains relatively steady at 41,234.
  • ACA Legislation: Governor Patrick filed a bill to reconcile state law with the ACA, another step forward in national health reform implementation.  The legislation is a result of active collaboration between several state agencies.
  • Seal of Approval: The deadline for insurance carriers to submit Seal of Approval (SoA) responses was May 1st.  Health Connector staff are actively reviewing the responses and will recommend plans to be granted conditional SoA in June.
  • Navigators: The Health Connector is also reviewing applications for the Navigator grant program, which were due April 30th.
  • HIX-IES: Earlier this week, the state completed its federal design review of its new eligibility and enrollment IT system (HIX-IES) and received favorable feedback.  The Health Connector’s focus is shifting from policy development to operational readiness.

National Health Care Reform Implementation Update

Implementing the ACA has been a major focus of the Commonwealth for the past two and a half years.  As Health Connector staff put it, the remainder of 2013 is the “home stretch” before the October 1st “Connector 2.0” go-live date.

Major Policy Milestones

In collaboration with other state agencies, the Health connector has made a series of important decisions to move ACA implementation forward:

  • Subsidized coverage: Expanding Medicaid and offering premium tax credits and cost-sharing reductions, with a wrap for enrollees below 300% FPL.
  • Exchange: Authorizing the Health Connector as the state’s ACA-compliant Exchange.
  • Technology: Building a new integrated eligibility and enrollment system, to serve both the Health Connector and MassHealth.
  • Market Reform: Maintaining the merged individual and small group market.
  • MCC & Individual Mandate: Maintaining the state individual mandate and many of the state’s minimum creditable coverage (MCC) standards.
  • Risk Adjustment: Administering a state-based risk adjustment program to help stabilize premiums.

Operational Readiness

The Health Connector is shifting much of its focus to operationalizing their policy and programmatic decisions.

  • HIX-IES: Developing a new eligibility and enrollment system, referred to as “HIX-IES,” is a custom-built IT system that allows the Commonwealth itself to own the system.  It will be implemented in two phases, with the hardware, connectivity and infrastructure setup substantially complete.  Coding requirements, design and testing is pending until program requirements are finalized.
  • Customer Service: Working with vendor Dell to provide customer service and business operations functions; the company has begun building its call center and designing key systems (e.g. premium billing).
  • Plan Management: Administering the SoA process and developing a web interface to transition insurance carrier information from the federal rate filing data system (SERFF) to the Health Connector.
  • Marketing, Communications & Outreach: Developing a multi-faceted and coordinated outreach, education and marketing strategy, of which the Navigator program is a part.
  • Member Transition: Developing an integrated member transition strategy for subsidized and unsubsidized Health Connector enrollees and coordinating outreach and communication activities with vendors.
  • Appeals & Risk Adjustment: Coordinating with MassHealth to develop an eligibility appeals system; obtained federal approval for Massachusetts-specific approach to risk adjustment.

Several Connector Board members commented on the need for the Health Connector to develop understandable information to share with stakeholders and consumers alike to make it clear who will be eligible for what program in 2014, and who specifically will not be eligible.  Jean Yang responded that development of these types of materials will be part of the Health Connector’s outreach, education and marketing work, which Kaitlyn Kenney is overseeing and will talk about at next month’s Board meeting.

Exchange Project Management Contract Extension

The Connector Board unanimously voted to extend the Health Connector’s contract with Deloitte through June 30, 2014 to provide ACA-related project management services.  In addition to project management, Deloitte provides support on customer service and business operations, Qualified Health Plan (QHP) and Qualified Dental Plan (QDP) certification, carrier integration, member transition, and product implementation. This contract has been funded through federal Exchange planning and establishment grants.

Final Chapter 224 Omnibus Regulations Transfer

Chapter 224 transferred responsibility from the Division of Health Care Finance and Policy (now CHIA) to the Health Connector.  The Connector Board voted to approve the transfer of these regulations to the Health Connector section of Massachusetts regulations:

Student Health Insurance Program: 956 CMR 8.00
Employer Free Rider Surcharge: 956 CMR 9.00
Health Insurance Responsibility Disclosure (HIRD): 956 CMR 10.00
Employer Fair Share Contribution: 956 CMR 16.00

The Health Connector had released these changes for comment on February 28th, and only received one comment.  The Alliance for Health Care Sharing Ministries requested adding language to the student health insurance regulations (SHP) to allow students to waive SHP if they are part of a health care sharing ministry.  Nancy Turnbull recommended that health care ministries are growing rapidly and the Health Connector should do due diligence to understand these arrangements and their broader implications before making any changes to regulations in the future.

The next Connector Board meeting is scheduled for Thursday, June 13th at 9:00am at 1 Ashburton Place, 21st floor.

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