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December Exchange Board Meeting: Federal Proposed Rules, Marketing and Outreach, QHP Designs, Health Disparities

During the last meeting of 2012 (possibly the world), the Exchange board discussed a myriad of topics with updates on several key topics.

Executive Director’s Report
During his monthly report, Peter Lee announced the tentative planning calendar for 2013, with the January meeting being held in Los Angeles.

The board has also submitted its Level 2 grant application for $750 million to the federal government last month, and a decision is expected in mid-January 2013. The blueprint application was submitted in mid December, and a certification decision is expected by January 1, 2013.

Jim Brown provided an update on CalHEERS, and outlined the revised release approach. Previously, Exchange staff planned to release in 3 phases beginning on July 1, 2013 through December 31, 2013. The revised approach has been fleshed out as follows:

Chief Technology Officer Juli Baker updated the board on the customer service center.

The general parameters for the service center are:

  • CalHEERS to determine eligibility and facilitate plan enrollment for consumers (Medi-Cal/Exchange)
  • Counties to handle walk-in customers, including Exchange and County programs
  • Drive to completion of enrollment from any point of entry into the system
  • Minimize “bouncing” customer back and forth, with one warm hand-off at most
  • Ongoing cases to be handled at the “agency of record” (e.g. Medi-Cal handled by counties; Exchange by Central Service Center)
  • Sort calls seeking eligibility for workload management between Service Center and Counties, with warm hand-off requirement to assure consistent service

The Quick Sort process was also outlined:

  • While the questions will be refined during design and based on experience, minimal sample questions will be used to sort. Examples include:
    • Number of people in family
    • Anyone seeking coverage under age 19 or pregnant?
    • Anyone seeking coverage for elderly or disabled?
    • Annual income?
  • Initial cut off points for sort to County:
    • Single, childless adults with incomes up to 138% of FPL
    • Pregnant women with incomes up to 200% of FPL
    • Children of adults not applying for coverage, household incomes up to 250% of FPL
  • Continuous review of referral metrics to determine the need for adjustments
  • All processes for the first year will be reviewed and revised where appropriate
  • Pending CMS review

Processes for multiple program families and paper application/verification issues were also addressed.

Federal Proposed Rules
Exchange staff highlighted the federal proposed rules that were recently released, and noted the comment deadline for specific subjects:

In particular, staff pointed out key areas for comment:

  • Geographic rating areas: proposed rule limits states to 7 rating areas, but allows states such as California to request more than 7
  • Essential health benefit substitution: California law prohibits substitution of essential health benefits but proposed rule is unclear regarding state authority to prohibit substitution
  • Actuarial value calculator
    • Calculator will be used to verify actuarial values of QHPs
    • AV calculator does not account for California’s lower utilization of health care service
  • Risk adjustment: Federal proposed risk adjustment methodology does not account for California’s delegated group model
  • Proposed rules on stand-alone pediatric vision EHB may be pending

Focus Groups for Marketing and Outreach Efforts
Larry Bye from the National Opinion Research Center (NORC) summarized findings from a qualitative study of uninsured and individually insured Californians to better inform marketing and outreach efforts. NORC conducted 412 in-person one-on-one interviews, covering 13 race/ethnic segments and 12 language with more than 30 interviews per language (English, Spanish, Korean, Vietnamese, Chinese, Khmer, Armenian, Farsi, Arabic, Russian, Hmong and Tagalog); 75% were uninsured and 25% private insured, 75% employed, and evenly split across gender, four age categories, income categories and family types.

Findings
The survey found that there was a low level of knowledge regarding the ACA with considerable confusion. Prior to learning about upcoming changes, 57% felt good about the ACA, with 35% unsure and 6% bad. After learning about Covered California, 94% of interviewees expressed interest in learning more; reasons are tabulated below:

Even more respondents (97%) expressed an interest in shopping through Covered California, with over 50% of respondents citing the ability to compare plans side-by-side as their main reason to do so.

NORC found that calculated risk takers (18-34 years old, more likely male, single, employed, white, 400% FPL+) are, by far, the least likely to purchase a plan, while underserved families (25-44 years old,

Qualified Health Plan Update
Andrea Rosen updated the board on QHP designs, including the current status of the standardized design, recommended changes to the out-of-network policy, model contract provisions, and a plan management timeline. Input is welcome on benefit design and model contracting provisions, and should be sent to qhp@hbex.ca.gov.

Also, David Panush summarized alternative strategies to promote affordability and safety net continuity through contracting with Medi-Cal managed care plans. Two options were presented:

  • Option 1. Contracting to achieve greater affordability – Covered California negotiates contracts with Local Initiatives, COHS or other Medi-Cal managed care plans with robust safety net provider networks to offer a plan option with very low or zero premium costs for those with incomes between 133-200% of FPL
    • Option 1.A – Best price option: Allow LI or COHS the first right of refusal, then allow any Medi-Cal managed care plan to place bids
    • Option 1.B: Allow any Medi-Cal managed care plan the option to contract
  • Option 2. Potential streamlining approaches for Covered California to encourage participation of Medi-Cal managed care plans

Either option may help maximize enrollment for low income Californians by offering an affordable plan option with very low premiums, and could reduce churn between Medi-Cal and  Covered California plans, while leveraging the existing Covered California procurement, contracting and quality mechanisms to promote efficient plan processes/oversight.  It could, however, add administrative complexity and give Medi-Cal managed care plans a competitive advantage in a section of the insurance market.

The health disparities panel has been postponed to the next board meeting, which will be held on January 18, 2013 in Los Angeles.  All meeting materials are available online.

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