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Connector Board Report: Lingering Legacy, and Moving Forward

Connector Board Report: Lingering Legacy, and Moving Forward

December 13, 2013

With just a few weeks before ACA coverage programs begin, the Connector Board met today to discuss website and coverage issues, vote on final regulations for student plans and the new ConnectorCare subsidized coverage program, and approve customer service and risk adjustment contract extensions.

This was the final meeting under the Connector's programmatic offerings that go back to 2006's Chapter 58. Starting in January, it will be Connector 2.0, the ACA Marketplace. But, as we learned today, lots of legacy infrastructure will linger into the new year for a while longer.  Materials from the meeting are posted here, and our full report just takes one click.

Jean Yang started with the Executive Director’s report, sharing final (and higheste ever enrollment numbers for the Commonwealth Care and Commonwealth Choice programs (which are phasing out):

  • Commonwealth Care: 216,995
  • Commonwealth Choice: 42,802

Yang also recognized the persistent technical problems with the Health Connector website, and said that the Connector’s highest priority is ensuring that everyone who needs coverage for January 1st will be able to get that coverage without gap or delay.  This week, the Health Connector started mailing invoices to consumers who have completed an application and selected a plan for unsubsidized coverage, and has begun to process applications for subsidized coverage.

2014 Open Enrollment Check-In

In our last blog post, we summarized the work-arounds the Connector is building to ensure that coverage will remain in place for current enrollees and that new applicants can get coverage on January 1st.  In general, people currently enrolled in certain subsidized coverage programs (Commonwealth Care, Medical Security Program, and Insurance Partnership) will have coverage extended through the open enrollment period, which ends March 31, 2014.  The Health Connector is reaching out to the 1,400 current Commonwealth Choice enrollees who reapplied for coverage and selected a plan to make sure they pay their premium by December 23rd for coverage effective January 1, 2014.

As for new applicants for subsidized coverage, the Health Connector is using a standalone tool outside of the HIX (Health Insurance Exchange, the new website) to make eligibility determinations and work with the call center on plan selection and billing.  If the Health Connector cannot process applications through this process, they will provide temporary coverage until they are able to process the applications appropriately.

As people continue to experience problems using the website and feel uncertainty about their coverage, calls to Health Connector customer service have drastically increased.  In response, the Health Connector has increased its customer service staff from 65 to 155 and will be adding more through December.

The Health Connector will continue to implement work-arounds to ensure everyone seeking insurance for January 1st can get it, and in the longer term, address the IT issues with a comprehensive action plan.

Approval of Final Regulations

In our report on the October Connector Board meeting, we reviewed the proposed Student Health Insurance and ConnectorCare regulations.

Today, the Connector voted to approve final amended regulations as proposed by Connector staff for both the Student Health Insurance Program (SHIP) and ConnectorCare.

Student Health Insurance
Based on comments from a variety of stakeholders, including comments submitted by Health Care For All and Health Law Advocates (pdf), the Health Connector made some changes to the proposed SHIP regulations, including:

  • Clarifying the scope of benefits SHIPs must offer
  • Adding by-term premium refund for students eligible for subsidized insurance or MassHealth
  • Allowing electronic waivers and designated representatives to conduct the waiver process.

Based on comments from several stakeholders, including the ACT!! Coalition comments, and those from Health Law Advocates, Mass Law Reform Institute, Mass Hospital Association, Mass League of Community Health Centers, the Connector made some changes to the proposed ConnectorCare regulations, including:

  • Drafting changes to certain definitions
  • Expanding the list of appealable actions to include assignment to a Plan Type
  • Clarifying that the Connector has authority to seek recoupment only if a member received unwarranted benefits through fraud
  • Clarifying that the provision of a special enrollment period for those who are determined newly eligible for ConnectorCare applies to applicants, not just current enrollees

Both sets of regulations will be effective January 3, 2014 and posted in the Massachusetts Register.

Commonwealth Care Customer Service Contract Extension

As the Health Connector extends coverage for current Commonwealth Care members through March 31, 2014, they proposed to also extend the contract with Dell Marketing LLP, the vendor that currently provides customer service for this population.  Board members commented on the importance of maintaining Dell’s services during the transition period and voted to approve the contract extension.

Risk Adjustment Update & Contract Extension

The Affordable Care Act (ACA) establishes premium stabilization programs for the small and non-group health insurance market, including risk adjustment.  Massachusetts operates a state-based risk adjustment program through the Health Connector, using state-specific data.  The program received federal certification in March 2013 and since then the Health Connector has worked with the Center for Health Information Analysis (CHIA) on program implementation.  The program hit key milestones in 2013, including:

  • Completed a full-scale simulation
  • Generated customized and detail data quality reports for every carrier
  • Worked with CHIA to enhance the All Payer Claims Database (APCD) submissions and intakes
  • Formalized standard operating procedures for the program

The Health Connector had been contracting with Milliman to provide support through this process, and recommended that they extend the contract through December 31, 2014 in order to hit key deliverables in 2014.  The Board voted to approve this contract extension.

The next Connector Board meeting is on Thursday, January 9th at 9am at 1 Ashburton Place, 21st floor.
-Suzanne Curry