December 2013

Open late neon sign
December 30, 2013

Ring in the new year with coverage. From the Health Connector:

In an effort to give applicants every opportunity possible to complete an application for health insurance coverage starting in January, the Health Connector’s customer service center will be open for expanded hours on Tuesday, December 31. For assistance on an application, call (877) 623-6765, from 7 a.m. through 9 p.m.

December 30, 2013
Dec 30 blog post photo

The season of giving is almost over and there are only two days left to donate to Health Care For All in 2013.

Please help us provide health care education, enrollment services, and advocacy that the people of Massachusetts deserve. In order to continue the important work we do and improve the quality and accessibility of health care for all Massachusetts residents, we depend on your generosity.

We invite old and new friends to consider making a gift today.

If you have not already made a donation to our annual fund and appreciate the work we do, please help out.

To make a tax-deductible donation:

• Click here to make an online donation
• Mail a gift to: Health Care For All, 30 Winter Street, Boston, MA 02108
• Dial a pledge at 617-275-2926

Celebrate and Remember
What better way to celebrate family and friends than to give a gift to HCFA in their honor or memory? Click here to make a donation or call 617-275-2926 to give today!

Online Giving Made Easy!
Make a contribution to HCFA via Network for Good. Simply select Health Care For All as your charity of choice.

Matching Gifts
Many corporations provide a 1:1 matching gift for their employees who donate to nonprofits. Please contact your Human Resources department today.

Monthly Donations
Support HCFA monthly by allocating an ongoing donation. Giving a specific amount each month has great impact on our work. Email freitas@hcfama.org to start the process today!

Workplace Giving
Join your employee giving program or encourage your company to become part of one. HCFA is a part of Community Works, the Commonwealth of Massachusetts Employees Charitable Campaign (COMECC # 111147) and the City of Boston Employees Charitable Campaign (COBECC #2015).

Thank you again for considering a donation to Health Care For All.  Because of your generosity, HCFA’s good work can continue.

December 24, 2013

Connector Deadline Extension 12-23-13

The Health Connector has just extended the deadline for many people to either select a plan and make their first premium payment. The Connector's release is here (bettermahealthconnector.org/application-deadline-extension/). (UPDATE: See the latest enrollment Q and A with Connector spokesperson Jason Lefferts on the 12/26 WBUR Commonhealth Blog) Headlines:

  • The new deadlines are Tuesday, December 31, to select a plan, and extended deadlines that give members additional time to make a payment.
  • For ConnectorCare members (people who receive state subsidies and federal tax credits, generally between 138% and 300% of the federal poverty level) who have completed an application and received a plan selection notice, they have until December 31 to pick a health plan. These members may not immediately be in the carrier’s system if a member contacts the carrier to check their status, but services used within the plan’s network will be covered starting January 1. ConnectorCare members will receive their first bill in January, which will request payment for both January and February premiums.
  • For Health Connector members who are receiving only federal premium tax credits as a subsidy (generally between 300% and 400% FPL), they also have until December 31 to pick a plan and pay their first month’s premium. If they need more time to pay their first month’s premium, they will be automatically enrolled in temporary coverage for the month of January, with the new plan taking effect on February 1, assuming payment is made.
  • For those who are purchasing health insurance with no financial assistance (former Commonwealth Choice), the deadline to pick a plan is December 31, with a deadline of making the first premium payment by January 10.  Coverage will not be effective until payment is received, and it may take about five business days after payment is received until the policy is reflected in the carrier’s system. However, these members will be eligible for retroactive coverage to January 1 when the payment is made and the carrier processes the enrollment. Payment by electronic fund transfer can be done only if the member takes that step immediately after plan selection. Otherwise, the member must mail a check or money order to the Health Connector, or visit the walk-in offices in Boston or Worcester.
  • Unprocessed applications seeking financial assistance will be placed in temporary coverage until the application is processed. Letters to those members will be mailed starting this week.

The Commonmwealth Fund's David Blumenthal had a smart observation today about these deadlines slipping:

The changing dates associated with the ACA are troubling to some, since they suggest confusion and even mismanagement by the Obama administration. It would obviously be reassuring if every declared date were honored and announced rules and intentions never changed. On the other hand, I’m doing some long-delayed repairs in my home. The contractor said the work would be done by Thanksgiving, but there were unanticipated problems. We’re hoping now for Christmas.  I’ll be happy if it’s done by mid-January, but the key thing is whether, a year from now, I’m satisfied with the result. Health insurance is obviously way more important to millions of Americans than any home repair project could ever be. But few things in life go exactly as planned, and it would be totally astonishing if the implementation of massive reforms to a sector accounting for 20 percent of our economy rolled out without a bump or a detour.  We should keep that in mind as we think about those changing ACA deadlines.

Click on for the full detailed Connector update:

Holiday appeal
December 23, 2013

As we approach the last days of 2013, please consider making a donation to Health Care For All. Below are the ways that you can support our efforts to ensure that everybody has high quality, affordable healt

Holiday Appeal

h care. What better way to celebrate family and friends than to give a gift to HCFA in their honor or memory? Click here to make a donation or call 617-275-2926 to make a pledge! Make a contribution to HCFA via Network For Good. Simply select Health Care For All as your charity of choice. Support HCFA monthly by allocating an ongoing donation. giving a specific amount each month has great impact on our work. Email freitas@hcfama.org to start the process today! Join your employee giving program or encourage your company to become part of one. HCFA is a part of Community Works, the Commonwealth of Massachusetts Employees Charitable Campaign (COMECC #111147) and the City of Boston Employees Charitable Campaign (COBECC #2015). To make a tax-deductible donation:

Click here to make an online donation

Mail a gift to: Health Care For All 30 Winter Street, Boston, MA 02108 Attn:Development Dial a pledge at 617-275-2926 Thank you for all of your continued support!

December 23, 2013

Economist Uwe Reinhardt has an apt description of how the complete lack of information around health insurance prices feels to consumers:

“Imagine a department store whose customers are blindfolded before entering. A shopper might enter the store seeking to buy an affordable dress shirt and a tie, but exit it with a pair of boxer shorts and a scarf. Sometime later, he would receive an invoice, whose details would be incomprehensible to him, save for one item: a dollar amount in a framed box with the words: “Pay this amount.”

Massachusetts is beginning to move away from this opaque-world and enter into transparencyland. A week ago, the Division of Insurance (DOI) issued a bulletin regarding the consume price transparency provisions that apply to health insurers as part of Chapter 224, the 2012 cost control and delivery reform law. The law states that Massachusetts health insurers must provide a toll-free number and website that enables consumers to obtain within 2 days the estimated or maximum allowed charged for a proposed admission, procedure or service, and the estimated amount the patient will be responsible to pay. Insurers will have to provide these estimates in real time by October 1st, 2014. Insurance carriers now have to tell you how much your health care costs, before you receive it. Through this bulletin, the DOI has provided more guidance on what insurers must do to comply with this law. The bulletin states that the DOI expects the following:

  • All systems must be consumer friendly.
  • Insurers must provide the anticipated charge and a consumer’s anticipate out-of-pocket costs for an admission, procedure or service based on general information available to the insurer at the time the consumer makes the request. The DOI recognizes that in some cases a insurer may not be able to obtain all the information necessary to provide a cost estimate to a consumer in one conversation and states that the “2 day” timeline will begin when the insurer has all the necessary information.
  • Although insurers can request more information from consumers, insurers do not need perfect information to provide a cost estimate, including and especially diagnostic or procedural codes. Consumers should not be required to provide the insurer with a “CPT code” to get a cost estimate.
  • If a CPT or diagnostic code is necessary to obtain a cost estimate, the insurer, with the consumer’s permission, should be responsible for obtaining it from the consumer’s health care provider.
  • Consumers should provide insurer with as much information as possible and insurers should request information that is minimally burdensome for the consumer to acquire.
  • The cost estimate can be provided via conversation, email or writing.
  • The insurer must provide the consumer with the anticipated total cost and the consumer’s out-of-pocket cost based on the available information at the time the request is made.
  • If the consumer wishes to do some comparison shopping and requests the cost estimate for more than one provider, the insurer must provide it in a clearer and easily comparable manner.
  • Insurer transparency tools must provide information for those who are visually impaired or otherwise unable to access information being provided by a insurer through its website or by telephone, or do not speak English as a first language.

We welcome this bulletin and congratulate the Division of Insurance and the Office of Consumer Affairs & Business Regulation for issuing the guidelines. As deductibles become more entrenched in our insurance design, consumers need a way to know the cost of the health care services they receive. Insurers must create transparency tools that are user friendly, clear, accessible and most importantly do not require consumers to have complex CPT or other codes on hand.

December 23, 2013

Connector Executive Director Jean Yang called it “a backup to the backup” in a Boston Globe article about plans in process to prevents gaps or delays in coverage despite major dysfunction in the state's online eligibility and enrollment processing system. On late Friday, MassHealth and the Connector released more information about the temporary coverage plan:

We recently informed you of the coverage extensions that apply to members enrolled in Commonwealth Care, Medical Security Program or the Insurance Partnership program allowing members to retain their current coverage through at least March 31, 2014.  As you know, the priority of the Health Connector and MassHealth is to ensure that everyone seeking insurance coverage has access to coverage without gaps or delay. We are currently experiencing some delays in processing applications through our new system, and are aware that some applicants who are not currently enrolled in any subsidized health insurance program may need access to health care coverage starting on January 1. We are working to process those applications and prioritizing applications from those who are not currently enrolled in any subsidized health program. Please be advised that any individuals not currently enrolled in any subsidized health program who have applied for subsidized coverage, and whose applications we have not been able to process, will have access to temporary coverage until we are able to process their applications and make final eligibility determinations. Individuals whose applications were submitted prior to December 31, 2013, will receive this temporary coverage starting January 1, 2014. In an effort to provide further clarification on this temporary coverage option for you and those applicants you assist, we have prepared and attached the following materials:

Individuals receiving temporary coverage or providers with questions about this option can call MassHealth Customer Service at 1-800-841-2900 (TTY: 1-800-497-4648) for more information.

 

December 20, 2013

HPC 2013 Accomplishments

The Health Policy Commission met Wednesday December 18, for its 11th full meeting. The bulk of the meeting focused on a presentation of the preliminary findings of the 2013 Cost Trends Report and an update on the Cost and Market Impact Review of the acquisition of South Shore Hospital and Harbor Medical Associates by Partners HealthCare.  The slide deck is here, and our full report is on the backside:

December 19, 2013

Re-Reforming Reform Part 2 coverIt's re-re-reforming reform. A part II sequel, like Revenge of the Nerds II: Nerds in Paradise. (We're not going to say Attack of the Clones).

What it is an updated, comprehensive, readable, understandable guide to all the changes happening to health coverage in Massachusetts due to the ACA. Today the Blue Cross Foundation released Re-forming Reform Part 2, by Elisabeth Rodman of the Foundation staff.

Re-Reforming Reform Part 2 coverage chartThe report looks at the changes to subsidized coverage for low income people, new eligibility and enrollment policies, altered regulations affecting private insurance, and also includes some payment reform initiatives.

If your reading this blog, you'll probably like this report. Get it here. -Brian Rosman

 

December 18, 2013

The Health Policy Commission’s (HPC) Quality Improvement and Patient Protection Committee held a hearing Monday on proposed amendments to 958 CMR 3.000, the Office of Patient Protection (OPP) regulation governing health plan internal and external appeals procedures.  The proposed amendments follow a listening session that OPP convened over the summer, and include consumer-friendly changes required by the Affordable Care Act (ACA) and Massachusetts state laws, as well as changes to provide additional clarifications and protections for consumers.

For example, some positive changes prompted by the ACA include a faster turnaround time for both expedited and non-expedited external reviews; more detail and clarity for information provided in consumer notices; allowing patients with urgent medical needs to file both expedited internal and external appeals simultaneously; and requiring refunds to consumers of the external review fee if the consumer wins the review.  And those are just a few of the improvements.

During the hearing, the Committee heard oral testimony from InterQual/McKesson Health Solutions, National Association of Social Workers (NASW), Massachusetts Association of Health Plans (MAHP), Health Law Advocates (HLA) and Health Care For All (HCFA), and Massachusetts Association of Behavioral Health Systems (MABHS).  Here are some of the points raised:

  • Jacqueline Mitus, Senior VP of Clinical Development and Strategy for McKesson Health Solutions and Laura Coughlin, VP of InterQual Development, raised concerns that providing criteria for medical necessity determinations to the public at no cost could breach confidentiality under intellectual property law and that the complexity of such information could create consumer confusion.
  • Jonas Goldenberg, Director of Clinical Issues and Continuing Education at NASW, recommended more stringent criteria for clinicians participating in review panels and advocated that services should be automatically continued pending the outcome of an appeals process.
  • Sarah Gordon Chiaramida, VP of Legal Affairs at MAHP, expressed concerns that requiring diagnosis and treatment codes on adverse determination notices would be confusing and may breach privacy protections by revealing protected health information to third parties. She further voiced concerns that the amendments around increased availability of translation services would be too costly and administratively burdensome for the health plans.
  • Clare McGorrian, Senior Staff Attorney and Director of the Commercial Insurance Appeals Program at HLA provided testimony on behalf of both HLA and HCFA. She advocated that medical necessity criteria should be determined by providers with more clearly defined clinical expertise and recommended that adverse determination notices more prominently display deadlines for action, especially for expedited appeals and continued coverage for ongoing treatment .
  • David Matteodo, Executive Director of MABHS, suggested that providers reviewing appeals be required to be licensed in Massachusetts.

The Health Policy Commission is accepting written testimony and comments from the public until 12 noon on Tuesday, December 24, 2013.  For details on how to submit testimony electronically or via mail, see the Hearing Notice.
 -Alyssa Vangeli

 

December 18, 2013

The Statewide Quality Advisory Committee (SQAC)  met this week for its final 2013 meeting. The group looked at an overview of the current Standard Quality Measure Set (SQMS), which includes 128 measures, 93 of which are mandated and 35 or which were recommended for inclusion by the SQAC after a measure nomination process. Seventy of the measures look at ambulatory care, 51 are for hospital care, and 7 look at care in post-acute settings (skilled nursing facilities and home health). Looking at the priority areas that are covered by SQMS measures, 20% of them are care coordination measures, 16% are chronic disease measures, 12% are preventive care measures, 9% are pediatric measures, 9% are behavioral health measures, 6% maternal and neonatal health care measures, 27% are other and 0% are patient-centered care measures. There was a lot of attention paid to patient-centered care measures during 2013 SQAC measures, with presentations on Patient-Reported Outcome Measures (PROMS) and patient confidence measures, as well as nominations for the inclusion of patient confidence and shared decision-making measures in the SQMS. While those measures were not chosen for inclusion, the SQAC will continue to look at them and, as CHIA Executive Director Boros said, will consider making stronger statements about their importance even if they are not included in the set. Based on the group’s discussion of domains and measure types that are under-represented in the SQMS, the next steps as outlined by Boros are for CHIA staff to:

  • Develop a straw model for reporting on a specific population;
  • Characterize existing SQMS measures as looking at overuse or unnecessary use of care, for those that do so, and propose other overuse measures that could be nominated for inclusion in the SQMS;
  • Start looking at measures relating to outpatient specialist care.

The next SQAC meeting is Monday, February 10, 3-5 at CHIA, 2 Boylston Street, 5th floor. Sometime following that meeting, there will be a solicitation process for proposed measures for the measure set. -Deb Wachenheim

December 17, 2013

UPDATE: An FAQ and an update from the Health Connector (Tuesday 12/17, 2 pm):

In accordance with Acting Gov. Galvin’s request to release all non-emergency employees today due to inclement weather, the Health Connector call center is closing at 2 p.m. today (Tuesday 12/17). The lines will re-open tomorrow at 7 a.m.

Question. What happens to an individual who is unable to get their application through online for January 1st coverage?

 Answer. Applying online is the fastest way to get coverage for January 1.  If you encounter any technical difficulties creating an account, call 1-877-MA ENROLL (877-623-6765) to complete your application. The Health Connector Customer Service Center has more than doubled its staff since October and is now offering applicants the opportunity to schedule an appointment with a Customer Service Representative who will call the applicant back within the applicant's choice of four blocks of time during a day that the applicant chooses.

 Question. Can you clarify to whom the temporary coverage for January 1st applies?

Answer. Our highest priority is to ensure that all of our populations that seek insurance coverage will have access to coverage without gaps or delay. If we are not able to process certain applications we will provide applicants seeking financial assistance with temporary access to coverage for January 1, 2014 until we are able to process them into their final new coverage. Those who have applied for non-subsidized coverage online or by paper MUST select a plan and make a payment by December 23 to enroll in coverage for January 1st.

Customer Service Center Update:

The Health Connector's Customer Service Center (1-877-MA ENROLL (1-877-623-6765) will offer extended hours this weekend.  They will be open on Sunday, December 22, from 9:00am-3:00pm to offer consumers assistance in completing applications or making plan selections.

 

As we mentioned in our blog last Friday, the Health Connector and MassHealth are doing the right thing by extending Commonwealth Care, Medical Security, and Insurance Partnership coverage until March 31st, 2014. Current members of these health insurance programs will need to reapply for help paying for health insurance between now and March 24th, 2014 in order to have health insurance for the rest of 2014. See details below about how to reapply and reenroll for coverage beyond March 2014.

What about the people that are losing health insurance coverage on December 31st or are currently uninsured?

The Health Connector and MassHealth have made a commitment to ensuring that folks are covered on January 1st, 2014. The details of this coverage are still being worked out, but we wanted to let our readers know so that the public is as informed as possible and hopefully to ease some anxiety.

How do folks ensure that they have health insurance coverage on January 1st, 2014?

There are four ways to get health insurance for January 1st:

  1. Apply online at mahealthconnector.org
  2. Apply over-the-phone by calling 877-MA-ENROLL (877-623-6765)
  3. Apply via paper application here for help paying for health insurance or here for health insurance with no subsidy
  4. Apply in-person with a navigator or certified application counselor. See the list of them here. [http://bettermahealthconnector.org/get-help/]

What if I already applied and have not received a notice about my new coverage?

The Health Connector and MassHealth are working furiously to process all of the applications they have received for health insurance coverage for January 1st, 2014. If you filled out a paper application for help paying for health insurance, you will receive a notice within the next couple of weeks regarding your new health insurance coverage that starts January 1st. If you filled out a paper application for private health insurance without help paying for health insurance, you will receive a notice very soon with your plan choices and/or bill for your premium*.

***Important note:  In order to have health insurance coverage for January 1st, 2014, you need to have sent in your completed application and premium payment (if you have to pay a premium) by December 23rd, 2013.***

UPDATE: Here's our summary of what people need to do to keep their coverage:

Affordable Care Act Coverage Transition Guide

For People Wanting to Apply for Immediate Coverage Before December 31st, 2013

  • Fill out a Virtual Gateway or the new application for help paying for health insurance. Make sure to check that you want immediate coverage!

For Current Commonwealth Care members (Over 138% FPL [Federal Poverty Level])

December 14, 2013

The Health Connector and MassHealth just sent out this update on contingency plans for health coverage in light of the ongoing issues with the eligibility IT (note that we have not posted the attachments, at the request of the Health Connector):

Over the last several weeks, the Health Connector, in close collaboration with our colleagues at MassHealth, have been working to ensure that people have coverage in place on January 1. As such, we have outlined several important updates about current health coverage programs and when individuals can expect to receive notification regarding their applications.

Update on Subsidized Health Coverage Programs:

Members in the following programs will have access to benefits through the end of March.

  • Commonwealth Care
  • Medical Security Plan
  • Insurance Partnership Employees

Current Commonwealth Care or Insurance Partnership (IP) members who are not being transitioned to MassHealth, as well as members of the Medical Security Program (MSP) who are enrolled in MSP on or after December 16, will have coverage through March 31, 2014. This means that if a current member in one of these programs has not submitted an application, or has not yet received a determination on their application, they still have through March 24, 2014 to apply, select a plan and pay their first month’s premium without experiencing a gap in coverage. Over the next couple of weeks, members in these programs will receive an official letter informing them of this update about their health insurance.

Sample Letter to Enrollees Regarding Coverage Extension:

  • The attached letter [note: not attached]  to Commonwealth Care members will go out this week to 110,000 members who will now have until the end of March to enroll into a new plan.
  • The attached letter [note: not attached] to members in the Insurance Partnership program will go out this week to approximately 1,000 members who are likely eligible for subsidies through the Health Connector, informing them that the IP program ends on December 31 and that MassHealth will make premium assistance payments directly to them during the QHP open enrollment period so that they have until the end of March to enroll in a new plan.
  • Letters to members enrolled in MSP are still under review and a draft will be shared once finalized.

Commonwealth Care members who have submitted an application will receive a letter this week informing them that they will still have access to coverage through March 31, 2014, and that their application for new coverage will be processed over the coming months. MSP members (enrolled through December 16) will have access to continuation coverage. For current Commonwealth Care and MSP members whose applications are successfully processed and who complete all steps to enroll in a Health Connector Plan prior to December 23, new coverage could be effective as early as January 1. Insurance Partnership members who are likely eligible for Health Connector coverage may apply for and enroll in coverage anytime between now and March 24.

Update on Applicants for Subsidized Health Coverage Programs:

Our highest priority is to ensure that all of our populations that seek insurance coverage will have access to coverage without gaps or delay. The Health Connector and MassHealth are working to process applications for subsidized coverage as soon as possible. We are prioritizing applications from individuals who are not currently enrolled in any subsidized health program and therefore do not benefit from the extensions described above. We have created an alternative path to process new applications for subsidized coverage and effectuate enrollment in a Qualified Health Plan with premium tax credits to help pay monthly premiums.

  • Members eligible to enroll in a Health Connector plan with premium tax credits, as determined through this process, will be sent letters explaining their access to subsidies and health plan choices, and are informed to return a plan selection form or call member service to select a plan (similar to the current plan selection process for Commonwealth Care). These individuals will also receive a Frequently Asked Questions document along with this enrollment letter.
  • Members eligible for MassHealth programs, as determined through this process, are enrolled in coverage through MassHealth’s legacy eligibility system, MA-21. MassHealth-eligible members can be enrolled in any coverage type that is available in 2014, including MassHealth CarePlus.

Sample Letter to ConnectorCare Enrollees Regarding Plan Selection:

  • The attached letter [note: not attached] has been mailed to applicants seeking financial assistance indicating that the recipient is eligible for a Connector Care plan type and lists the ConnectorCare plans they can choose from as well as the methods to complete their enrollment (mail, phone, in person, fax). The letter states that a final determination notice will be sent in the mail once the application process is complete. The letter also mentions that if the recipient has questions s/he can reach out to Navigators in addition to Certified Application Counselors or Customer Service for further assistance.

If we are not able to process certain applications through this workaround (e.g., due to data limitations), we plan to provide applicants with temporary access to coverage for 1/1/2014 until we are able to process them into their final new coverage.

Update on Non-Subsidized Health Coverage Programs:

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