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Connector Prepares for New Business Model

Connector Prepares for New Business Model

November 21, 2012

On Friday, the Connector Board met to discuss customer service and business operations changes needed for ACA implementation and voted to release draft regulations on the small business wellness program. Materials from the meeting are here.

Customer Service Technology and Business Operations

The Connector’s customer service and business operations needs are changing due to implementation of the Affordable Care Act (ACA). Currently, the Connector administers two separate programs: Commonwealth Care (subsidized coverage for individuals) and Commonwealth Choice (unsubsidized coverage for individuals, families and small businesses).

Under the ACA, the Connector will run a single integrated program for individuals (subsidized and unsubsidized) and small employers, which requires new technology-driven customer service and business operations capabilities including:

• Call center support for real-time, integrated eligibility determinations for premium tax credits and cost-sharing reductions.
• Consumer support in navigating new products, programs, and subsidy calculations.
• Member support using online tools, such as web chat and email message centers.
• Assistance for new populations (e.g. in the future – businesses with up to 100 employees).
• Establish a Customer Service Contact Center where members can receive assistance by phone, email, online chat and in person.

On Friday, the Connector issued a Request for Proposals (RFP) from vendors who can provide these new capabilities. The Connector plans to select a bidder by January 30, 2013.

Sub-Connector Licensing Procedures RFI
Under Chapter 58 of the Acts of 2006, the Connector has the authority to license sub-connectors, which are local organizations with experience in the small business health insurance market. On Friday, the Connector released a Request for Information (RFI) seeking feedback from market stakeholders on their proposed straw man model to license sub-connectors.

The proposed model creates formal links between the Connector and “alternative distribution channels” (e.g., brokers and business associations) to increase access to qualified health plans (QHPs) and wellness programs offered by the Connector. Sub-connectors would be licensed to sell all QHPs the Connector offers to small groups, but it is the sub-connector’s responsibility to establish agreements with carriers to distribute these plans. Sub-connectors will also be required to perform administrative functions, such as enrollment, customer service and premium billing, for all small businesses that enroll through them.

Wellness Track premium rebates will be available to small employers who shop and purchase a plan through the Connector using the proposed sub-connector straw man model. If permitted by the federal government, the Connector also intends to offer ACA small business tax credits to groups that purchase a Connector plan through a sub-connector.

Connector Board member Dolores Mitchell sparked a discussion about whether the sub-connector model is in the best interest of the Connector. Robin Callahan (MassHealth) responded that she understands the model as creating more roads to the Connector. Glen Shor noted that the proposed model is structured in a way that works with the market and the RFI is intended to gauge market reaction and help refine what the sub-connector model. Connector staff plan to come back to the Board with feedback from the RFI in early 2013.

Small Group Wellness Incentive Program
Chapter 288 of the Acts of 2010 created a small business wellness rebate program through the Connector to encourage small employers to participate in wellness activities. The original statute limited eligibility to small employers that qualified for ACA tax credits – employers with fewer than 25 employees and an average annual salary less than $50,000.

However, the Connector found these eligibility criteria too limiting, as most small employers’ salaries at the ACA-required level typically do not offer health insurance. To address this problem, last year’s state budget included language to allow the Connector to redefine eligibility for their wellness program – known as Wellness Track – through regulations.

Connector staff recommended the following updated eligibility criteria:

• Eliminate the salary restriction
• Make small groups eligible for rebates for three years as long as they complete the wellness requirements
• Make the program available to small groups that purchase directly through the Connector and those that purchase through a Connector-licensed sub-connector

The Connector Board voted to release these draft regulations for comment, with a public hearing scheduled for January 3rd.

The next Connector Board meeting is scheduled for Thursday, December 13th, 9:00 am at 1 Ashburton Place, 21st floor.

-Suzanne Curry