Do Not Mock the MOCC

MOCC slide

MOCC stands for the “Massachusetts Operational Command Center.” It’s the structure set up by Sarah Iselin, the Governor’s special assistant tasked last week with managing the repair of the states health insurance enrollment website and underlying IT. Monitoring operations around the clock, and holding a accountability “Quarterback Call” meetings twice a day – 9:00 am and 5 pm, the center is modeled after the federal Exchange Operations Center in Columbia, MD that fixed the healthcare.gov website.  It’s up to the MOCC to get things working for Massachusetts health care. Do not mock the MOCC.

Jean Yang, the Connector’s Executive Director began today’s Connector Board meeting with a forceful and heartfelt statement about the challenges the Connector team and the residents at large are facing.  She thanked the Connector Board for their support and for “keeping their eye on the end game” and pledged to effectively engage the Board during this challenging time.

Yang admitted that the current workarounds to get people coverage are not working well enough, despite extremely hard work by staff.   To Yang, the two most urgent issues raised at yesterday’s legislative hearing about the IT issues include:

  • What the Commonwealth can do to get out of this situation ASAP; and
  • People need help, and the current workarounds are not yet sufficient.

Meeting materials are posted on the Connector’s website (go to About, Leadership, Board Meetings and scroll to Feb. 13), except the open enrollment presentation, which is here. Our report takes just one click.

2014 Open Enrollment Check-in

Sarah Iselin presented to the Connector Board for the first time in her new role as the Special Assistant to the Governor overseeing the Connector website and IT fixes.  She presented the board with an overview of the new management and governance structure on the project.  Iselin reports directly to the Governor and briefs him on a daily basis; she is also the person responsible for managing the contracts with the two IT vendors, Optum and CGI.  Under Iselin’s leadership, the Administration launched the Massachusetts Operational Command Center (MOCC) at MassHealth offices in Quincy – where the day-to-day work on the coverage workarounds and IT fixes happen.

According to Iselin, the Administration’s highest priority is to “ensure that coverage is available to all without gaps or delay.”  As of today, the Health Connector has enrolled 8,400 individuals and families into Qualified Health Plans (QHPs), most of whom sought unsubsidized coverage.  Iselin is in charge of developing a roadmap to enroll individuals in ACA-compliant coverage.  She will share progress on standard metrics at weekly public briefings, the first of which will be next week.  The briefings will occur on Friday mornings, except on weeks when there are Connector Board meetings, in which case the weekly briefing will occur during the board meeting.

Perhaps the biggest news of the day is that CMS granted Massachusetts an extension of Commonwealth Care and temporary coverage through June 30, 2014, which will give the Commonwealth more time to transition residents into ACA-compliant coverage.  Today, Commonwealth Care has about 124,000 members, while 31,000 residents new to subsidized coverage are receiving temporary coverage through MassHealth.  Within the next couple of days, MassHealth will enroll 25,000 additional residents who applied for subsidized insurance in January into temporary coverage retroactive to February 1, 2014.  The Commonwealth is receiving 50% federal match for both extended Commonwealth Care and temporary coverage.

Board member Dolores Mitchell stated that the Connector and MassHealth need to make retroactive coverage more explicit to consumers and providers to ensure consumers can receive services and will not be on the hook for medical bills.  Sarah Iselin responded that there are still about 50,000 paper applications in the backlog that are not yet entered into the system and put into temporary coverage.  Some of these applications are from current Commonwealth Care members whose coverage is protected but others may be uninsured.  Iselin stated, “It’s not just a retro problem, we need to catch up” with the applications, which she said will be the first order of business.

Connector Deputy Executive Director Ashley Hague clarified that there is no extension of the open enrollment period itself, which is required by federal law to occur between October 1, 2013-March 31, 2014.  However, people who have a qualifying event (e.g. lose coverage) can purchase coverage outside the open enrollment period.  In addition, MassHealth will continue to have continuous enrollment throughout the year and being determined eligible for ConnectorCare is considered a qualifying event to purchase coverage.

Residents seeking unsubsidized coverage – including current Commonwealth Choice enrollees – will need to reapply for and reenroll in coverage by March 31, 2014, unless they have a qualifying event.  Thus far, about 4,500 new people have enrolled in unsubsidized QHPs through the Health Connector.  On top of that, 2,200 Commonwealth Choice enrollees have already transitioned to QHPs.

Workaround process slide

Deputy Executive Director Roni Mansur walked through the workaround processes for residents seeking coverage.  While the process for those seeking unsubsidized coverage is not as challenging as the process for those seeking subsidized coverage, there are major issues.  For all applicants, the system does not work with certain web browsers (for instance, Internet Explorer 11).  The site is also riddled with time outs, error messages, and slow performance.  There have been instances of subscribers sending in their payments and not receiving confirmation that they are covered – the system is unable to match the consumer’s check with the billing system information.  There is a current backlog of 300 of these cases; 1800 have already been resolved.

On the subsidized coverage side, the issues are more complex, as the eligibility system itself is not working properly.  Due to the website issues, most people are submitting paper applications, which are processed by MassHealth staff.  Each paper application takes two hours to process.  Subsidized coverage plan selection does not work – people need to select a plan by phone.

In addition, there is no system in place to deal with information or life changes, for instance, a new address or a new baby.  There are currently between 2,500-3,500 cases the Connector is trying to work though.  Only about 1% of these cases involve life changes such as a marriage or the birth of a child.

The Health Connector has recently posted a list of tips for applying online and known issues here http://bettermahealthconnector.org/get-help/help-center/.

Board member Nancy Turnbull asked for more details on how the process for expediting applications for people with urgent medical needs and what improvements will be made. Ashley Hague responded that the Connector has an escalation team, which will be supplemented by staff from Optum.  According to Hague, for those seeking subsidized coverage, the Connector is working with MassHealth to push people with medical need through the system or put them in temporary coverage.  For those seeking unsubsidized coverage, the Connector is working directly with carriers.  Iselin added that this process will be included in the workaround improvements.

Proposed 2014 Affordability Schedule

In 2012, after convening a stakeholder advisory committee, the Connector decided to maintain the state’s individual mandate in addition to the federal mandate, in large part to maintain the state’s more comprehensive coverage standards.  According to Connector staff, the size of the population potentially impacted by maintaining a state mandate is small.  Last year, the Connector Board approved a three year phase-in approach to align with the federal affordability standard, while maintaining a progressive schedule.  The goal was to adopt the federal 8% standard for those at the highest income levels.  As such, the 2013 Affordability Schedule caps premium contributions at 10% of income.

For calendar year 2014, Connector staff propose the following:

  • For people earning at or below 300% of the federal poverty level (FPL), maintain income brackets and dollar-based affordability amounts based on ConnectorCare base premiums;
  • For people earning between 300-400% FPL, allow an additional year to adopt the 8% federal affordability standard; and
  • For people earning more than 400% FPL, adopt an 8% of income affordability standard.

The board voted to release the proposed 2014 Affordability Schedule for public comment.

Insurance Enrollment Files

Systems issues have not only affected consumers trying to enroll in coverage, they have also impacted the way in which the Health Connector sends enrollment to insurance carriers so consumers can actually utilize the benefits offered by the plan of their choice. Prior to January 2014, enrollment files for subsidized coverage were sent via the MassHealth MMIS system and files for enrollees in unsubsidized coverage were managed by the Small Business Service Bureau (SBSB).  Originally, the implementation of the “834” file transfer was part of CGI’s scope for the HIX/IES project, but has been pushed back several times.  In the meantime, the Health Connector has been sending spreadsheet-based enrollment files, which require inefficient manual data entry on the carriers’ side.

The Connector proposed entering into a contract with Dell for development and implementation of the 834 file transmission.  Dell will be paid only if they meet specific criteria laid out by the Connector.  The Connector Board voted to approve this contract.

The next Connector Board meeting is scheduled for Thursday, February 27th at 9:00am at 1 Ashburton Place, 21st floor.
-Suzanne Curry

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