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Health Connector Discusses Bylaws, Plan Offerings and Budgets

Health Connector Discusses Bylaws, Plan Offerings and Budgets

July 19, 2016

Last Thursday, the Health Connector Board met to update their bylaws, award conditional Seal of Approval to health and dental plans, and review the Health Connector’s FY2016 final and FY2017 proposed administrative budgets. Materials from the meeting can be found here.

Executive Director’s Report

Health Connector Executive Director Louis Gutierrez provided updates on Connector activities.

  • July enrollment increased by 10,500 members
  • 7500 members were overcharged for their premiums; the Connector has worked with Dell to rectify the situation and ensure members receive refunds
  • Risk adjustment payment to carriers increased by $84 million, largely due to an increase in Qualified Health Plan (QHP) member months
  • The Health Connector is considering their options to the Small Business Health Options Program (SHOP) and employee choice program. The Health Connector cancelled the SHOP procurement after not receiving any good options.
  • Preparations for 2017 Open Enrollment are under way.

In response to the SHOP updates, Board members discussed and inquired as to whether implementing a SHOP system would be a waste of time and money and whether this feature of the ACA is able to be waived. Gutierrez responded that it is waivable under Section 1332 authority, but it would be very difficult to obtain approval. The Health Connector is considering a shared platform with other states such as Connecticut, Rhode Island and Washington DC as an alternative.  

Patricia Wada provided an update on the roadmap for IT systems upgrades. The next release in August will focus on repairs and user experience upgrades to prepare for 2017 Open Enrollment, allow for Spanish language notices, and plan management features. The HIX system is a joint effort between the Health Connector, MassHealth and Mass IT. One Board member questioned whether the IT system will be impacted by MassHealth’s delivery system redesign and implementation of Accountable Care Organizations (ACOs). Gutierrez responded that this is on their radar and they are planning very far ahead.

Update to Bylaws

Ed DeAngelo and Ashley Hague presented proposed updates to the Health Connector Board bylaws, which have not been updated since the Connector’s inception in 2006. Updates focused on the designation of the Secretary of Health and Human Services as the board chair, the allowance of Board members to be notified of scheduling matters via email, the shift of responsibility from Executive Director to a Health Connector employee to be responsible for meeting minutes, and the allowance of the election of a vice chair to occur any time during the final quarter of the year, depending on each monthly agenda were each enacted.

There were also a few contractual updates to the bylaws. This included the an update to the minimum dollar value (from $5,000 to $15,000) for contracts that do not require a formal vote, but do require a written notice to the Board 5 days before execution. The type of “contract” requiring Board vote was then specified as “any and all types” except for extensions, amendments and work orders that cost less than a quarter of the original contract, as long as the cost is noted in the most recent Board approved fiscal budget. The Board voted unanimously to approve the amended bylaws.

Conditional 2017 Seal of Approval

In response to the 2017 Seal of Approval RFR, there will be a 25% decrease in health plans offered through the Connector when compared to 2016. Unlike 2016, when only non-standardized Bronze plans were offered, the Health Connector created, two new Standardized Bronze plans - one MCC-compliant and the other  has-compatible. All carriers opted for the MCC-compliant Bronze  plan design. In addition, the second standardized Gold plan was also eliminated. In total, 10 medical carriers responded to the 2017SOA ,submitting 62 QHPs for both non-group and small group shelves.

Notably, one of the new goals of the SoA expressed by the Health Connector is  enhanced substance use disorders treatment 2017 ConnectorCare plans will offer enhanced access to Clinical Stabilization Services and reduce the cost burden for key MAT (medication-assisted treatment) and associated services.

Another change is the requirement for QHPs to include pediatric vision and dental services, as per the State’s updated Essential Health Benefits (EHB) requirement Requiring Pediatric dental EHB coverage would move the Health Connector into parity with the off-exchange market, increasing the accessibility of these services. While one carrier cited operational challenges as a barrier, most opted to include pediatric dental benefits into their plans. On the dental carrier side, there were not many changes to the requirements and offerings of Qualified Dental Plans (QDPs).

The Health Connector voted and approved the 2017 Conditional Seal of Approval for  recommended QHPs and QDPs from the following carriers:

  • Altus Dental
  • Blue Cross Blue Shield of MA
  • Boston Medical Center HealthNet Plan
  • CeltiCare Health
  • Delta Dental of MA
  • Fallon Health
  • Harvard Pilgrim Health Care
  • Health New England
  • Minuteman Health
  • Neighborhood Health Plan
  • Tufts Health Plan – Direct
  • Tufts Health Plan – Premier

Health Connector FY2016 & FY2017 Administrative Budgets

FY2016 was a challenging year due to the phasing out of federal funding for operations. The FY2016 year-end projection results in a $13 million net loss, an improvement of $2.8 million compared to original projections. The Health Connector will use reserves to fill the budget gap., The FY2017  budget recommendation includes a net loss of $4.4M, reflecting stabilization activities, use of revenue from the Commonwealth Care Trust Fund, the new Dell contract, lack of federal grant revenue for operations, HIX operations and maintenance, and increased ConnectorCare enrollment. The Board unanimously approved the FY2017 budget recommendation. 

The next Connector Board meeting is scheduled for Thursday, August 11th from 9-11am at 1 Ashburton Place, 21st floor, Boston.

-Chelsea Canedy & Suzanne Curry