The Connector Board met Thursday to discuss Commonwealth Care regulations, Minimum Creditable Coverage issues, and the Commonwealth Choice Seal of Approval. Most of the meeting was spent seeking consensus on three difficult issues that the Connector has encountered in the course of the MCC certification process. The meeting wrapped up with a discussion of the different levels of CommChoice insurance and the benefits and costs that each entails. Materials are here; our full report is below the fold.
Administration and Finance Secretary Leslie Kirwan began the meeting by giving an update on the state budget. While acknowledging the difficulty of a multi-billion dollar gap between the Governor’s original and revised budgets and the House and Senate budget, Secretary Kirwan underscored Governor Patrick’s support for keeping 28,000 legal immigrants on CommCare. Kirwan also conceded the difficulties of declining revenues in the state budget while CommCare case loads continue to increase.
In his Executive Director’s report, Jon Kingsdale celebrated the BMC HealthNet achievement of NCQA accreditation. He also remarked on the continued expansion of the new MCO, CeltiCare and accompanying continuing controversy regarding access to family planning services. Finally, he gave a quick update on national health reform efforts, including the robust role of Gateways, which will play a Connector-like role in state implementation of a national individual mandate. In the proposed federal bill from Senator Kennedy’s Health, Education, Labor, and Pensions Committee, Gateways would have primary jurisdiction over subsidized health programs, and he wished Connector Board member Jonathan Gruber luck before he leaves to testify before the committee in Washington, D.C.
Jaime Katz, the Connector’s General Counsel, delivered two presentations to the board, the first on CommCare Regulations and the second on issues with MCC certification. The first presentation explained the regulatory testimony the Connector received as well as the staff’s recommendations for changes. Issues addressed included providing more flexibility for the Connector Board to look back at assigning individuals to MCOs, ending payment plans for members who have trouble paying contributions, and providing authority to the Board to dismiss appeals of individuals who do not respond to requests for information. Thanks to submitted testimony, the “lookback” period for the Connector was resolved to be not less than ninety days; hardship waivers were broadened so as to be issued if medical expenses are 7.5% of income; and medical costs accrued during the gap period while one isn’t covered may now be considered for the waiver. Nancy Turnbull asked for more specificity about categories of hardships that will be considered, and a hardship waiver memo will be sent to the Connector Board next week that will address that question and others. The changes were voted on and passed unanimously.
Next Katz presented the three primary issues that the Connector staff has encountered during MCC certification:
- drug caps in self-insured plans;
- some collectively-bargained plans between employers and unions; and
- an exclusion of maternity benefits for subscriber dependents in self-insured plans.
There are currently a small number of self-insured plans that have presented $5,000 – 25,000 caps on their prescription drug benefits. These plans are otherwise MCC compliant and may even be more generous than other MCC compliant plans. The Connector staff has, to date, rejected any waiver request from a plan with a drug cap. However, prescription drugs are not considered a “core benefit” by the regulations and are therefore not automatically exempt from caps–making it a worthy discussion point for the Board.
Rick Lord asked whether these self-insured plans were at least equal to the Bronze-level plans that CommChoice offers. Katz replied that they are likely not. Nancy Turnbull commented that drug caps are inconsistent with market standards and that insurance should be based not on the average amount paid for prescription drugs but on those who pay the most. Everyone who followed agreed, with Jon Gruber adding that he wants to give the plans with prescription drug caps (as well as maternity exclusions) time to change, but that there is a right way to deal with increasing costs. Gruber said that if insurers are worried about costs then they should raise deductibles instead of using caps.
Employers and unions have asked Connector staff to approve two plans for part-time workers that do not meet MCC – both had low annual and prescription drug caps, as well as lifetime caps. Workers do not pay premiums and have low or no deductibles on these plans. They are set to expire in December 2010. Katz said that any exemption offered for these plans would last until December 2011. If these collectively-bargained plans are disallowed, most workers on them would likely go onto CommCare. Nancy Turnbull said that while the collective-bargaining was clearly not MCC-compliant, an exception should be made for the plans until they expire, and it should be made clear that any new plans would need to be MCC-compliant. Lou Malzone added that he thinks that it is unfair to punish collectively bargained plans, as they were negotiated before MCC standards were established.
The third issue raised concerned exclusion for maternity benefits from some self-insured plans. While exclusion of this benefit is not permissible by an employer purchasing a fully-insured plan, it is permissible for self-insured plans which operate under federal law. The Board came to a consensus that this maternity exclusion is, like prescription drug caps, inconsistent with market standards and found it to be discriminatory, reasoning that it is fundamentally different from other exclusions (e.g., physical therapy) since it singles out one type of insurance class – women.
After discussion on the MCC certification wrapped up, Patrick Holland, Chief Financial Officer of the Connector, presented an update on the Commonwealth Choice Seal of Approval. The goal of the Seal of Approval process was to offer high value plans in a simple way with minimal risk selection. The Connector Board will vote on this at its next meeting, June 23rd (note the added June date). The recommended suite of products included nine plans – one Gold, three Silver, three Bronze, and two Young Adult Plans – down from twenty-one (much to Lou Malzone’s delight). The staff presented a series of slides showing the benefit packages (including co-payments, deductibles and co-insurance) for each of the nine plans. Holland also described the intentional ‘benefit buy-down’ of the plans so that the premiums could be lower. Holland discussed three member Value-Added Options that plans may be allowed to offer: waiving co-pays for preventive care office visits, allow three PCP office visits subject to co-payment only for YAP plans, lowered cost-sharing for inpatient mental health services. The staff will integrate Board member comments from today’s meeting and bring final recommendations to them at the next meeting.
Kingsdale highlighted that DHCFP is engaging in a review of QSHIP plans, on which YAPs are based, and that the Board will likely revisit these plans again soon.
Before the close of the meeting, Secretary Kirwan issued congratulations to Martha Bebinger, the winner of a prestigious Nieman fellowship for journalism study at Harvard. Well deserved, Martha!
-Josh Rosmarin
