The Connector Board met on Friday afternoon to approve the revised Minimum Creditable Coverage (MCC) regulations and discuss updates on the CommChoice contributory plan and the CommCare program. Materials from the meeting can be found here.
Although the MCC topic has been contentious, the board reached a consensus on a package of changes, increasing some flexibility for 2009 and adding some stringency for 2010 (press release). Overshadowing the process was the state’s fiscal crisis, though health reform remains on track. Click on the (more…) for our full report.
First on the agenda, the Board voted to re-appoint Board member Dolores Mitchell as Vice-Chair. Secretary Leslie Kirwan reminded the Board that although the Governor made significant budget cuts earlier in the week because of the bleak fiscal situation, there would be no caps on enrollment, cuts in benefits, or changes to eligibility for public health programs. The MassHealth Outreach and Enrollment grants were preserved; Board member Celia Wcislo praised HEFA (Massachusetts Health and Educational Facilities Authority) and the Connector for contributing $2 million and $500,000, respectively, to fund the outreach grant program.
In his Executive Director’s report, Jon Kingsdale announced plans for the launch of the CommChoice contributory plan in mid-November. Kingsdale stated that the Connector was also on schedule for the transition to the new CommCare customer service vendor, Perot Systems, in early November. Kingsdale thanked the Connector staff for designing and producing the 2007/2008 Massachusetts Health Care Reform Progress Report, which brings a human face to health reform. We loved the report to, and will link to it as soon as it’s posted.
Minimum Creditable Coverage Regulations
Secretary Kirwan opened the MCC portion of the meeting by commenting that the revised MCC regulations reflect the notion of balance and thanking all of the Board members and organizations for their guidance and support. Kirwan emphasized that the Connector’s work with MCC will be a continual process as the Connector works to implement the requirements and closely monitor the impact of the changes.
Bob Carey, Director of Planning and Development, and Jamie Katz, General Counsel, led the Board through a presentation on the revised MCC regulations. The revised MCC regulations provide more clarity on preventive care guidelines, and require that the underlying health benefit plans in high deductible health plans and health savings accounts include core and broad services and pre-deductible preventive care.
Effective January 1, 2009, creditable plans must offer a broad range of medical benefits, which includes preventive and primary care, emergency services, hospitalization, ambulatory services, prescription drugs, and mental health and substance abuse. On January 1, 2010, the list of broad services will be expanded to include diagnostic imaging and screening, maternity and newborn care, medical/surgical care and radiation therapy and chemotherapy. Dolores Mitchell clarified that diagnostic imaging and screening could be managed through prior authorization. The revised regs allow plans to impose limitations in benefits, but plans will not meet MCC if benefit limits are inconsistent with standard employer-sponsored coverage and limits do not represent innovative ways to improve quality or manage the utilization or cost of services delivered.
Board member Ian Duncan questioned how the Connector defines standard employer-sponsored coverage. Bob Carey and Jamie Katz responded that the Connector would compare the benefit limits with benefit limits from many other employers to assess consistency. The revised regs also include a safe harbor provision: if plans come close to meeting MCC, the carrier or plan may request a Connector certification of MCC compliance if the plan’s health benefits cover core and broad services, benefit limitations are consistent with MCC requirements, and plan benefits have actuarial equivalence equal to or greater than CommChoice bronze plan. Ian Duncan commented that verifying the actuarial equivalency of all the plans that came close to meeting MCC would be an overwhelming administrative burden on the Connector, particularly for small employers – the onesies and twosies. Jamie Katz replied that the Connector’s research shows that only a few plans would not meet MCC requirements. Dolores Mitchell requested that the Connector keep track of plans that are granted this exemption. Board member Nancy Turnbull stated that the safe harbor provision provides increased flexibility for plans; Celia Wcislo echoed this comment by explaining that this provision ensures that large, national companies that offer great benefits, but lack one MCC requirement, would not have to change their plans. Jamie Katz and Bob Carey added that the Connector will seek guidance from the Board on setting up a flexible appeals process.
Recognizing the difficulty of opening up multi-year contracts, the revised regs allow the Connector to determine that collectively-bargained plans are compliant with MCC for up to one year following the expiration of the collectively-bargained agreement. The revised regs include technical corrections that address prohibitions on limits on core services, prescription drug deductibles, alternative prescription design, out-of-pocket maximums, and indemnity fee schedules.
Praising the revised regs, Dolores Mitchell declared that the Board “should be proud” and Lou Malzone expressed that he was “impressed and pleased”. However, Tom Dehner raised concerns that the regulations were over-prescriptive. Dolores Mitchell supported the revised regs by stating that nationally, insurance is moving towards more restrictive coverage, not more generous benefits. The Board briefly discussed the tensions between more specific regulations that offer more patient protections and the burden of complexity. Nancy Turnbull commented that the Connector will likely have to get more specific when giving guidance, especially on coverage and limits of non-core services. Celia Wcislo remarked that more consumer education is needed so that people can better understand the benefits offered by their plans. Rick Lord asked the Connector staff to be generous and flexible in the appeals process. The Connector is scheduled to issue Administrative bulletins and guidance documents for the Board to review at the November meeting and in the future. The Connector plans to engage in a public outreach and education campaign from mid-October through 2009. The Associated Industries of Massachusetts (AIM) are making presentations to employers across the state to explain MCC requirements.
The Board voted unanimously to approve the revised MCC regulations.
CommChoice Contributory Plan:
Cheryl Everett of CommChoice walked the Board through the product shopping experience for the CommChoice contributory plan. The contributory plan is available for small employers with 1-50 employees. The Connector has been meeting with broker groups for the past few weeks, and has received very positive feedback from the first round of broker trainings. The contributory plan allows brokers to input demographic information about workers, and then get quotes from many plans. The employer “shops” for coverage options and selects a contribution level (50% minimum contribution), coverage tier, and benchmark plan. The employee chooses a plan among several carriers offered through the contributory plan. According to Cheryl, the shopping experience is similar to selecting a CommChoice plan on the Connector’s website. The pilot program for the contributory plan is scheduled to launch in mid-November for coverage beginning in January or February, 2009.
CommCare Quarterly Program Update
Melissa Boudreault, Director of CommCare, presented the Quarterly Program Update to the Board. Melissa explained that the overall case load for the CommCare program has decreased each month since March due to a more people being terminated from the program then added. More than 17,000 members were terminated from September to October.
Board member John Gruber questioned whether the 225,000 enrollment projection would be modified given the recent decreases in enrollment. Jon Kingsdale responded that the Connector is re-projecting enrollment numbers and will share this information with the Board. Melissa told the Board that 20% of Plan Type 2A (100-150% fpl) members are now paying premiums because they did not choose the cheapest plan available during the open enrollment period this summer. Overall, there have been no significant shifts in enrollment by MMCO for the first quarter of FY09, but Neighborhood and Fallon have experienced slight increases in enrollment. The rate of dis-enrollment for failure to pay premiums remains low, and members are continuing to ask for payment plans. Membership demographics (age and gender) have also remained stable. Melissa stated that the Connector received good input from the recent community informational sessions. Nancy Turnbull raised the idea of expanding CommCare eligibility to people with unaffordable offers of employer-sponsored coverage and asked the Connector to look at this issue on an experimental basis.