Home » Blog » Covered California September Board Meeting

Covered California September Board Meeting

Like a gloriously terrible/wonderful film franchise, recent board meetings have been fast and somewhat furious, with a wide range of discussion/action items. Below is a summary.

–       CalHEERS on track to being ready October 1 (self-service and assisted enrollment functionality)

  • Some features not critical for Day 1 enrollment will roll out in scheduled maintenance releases in weeks following October 1
  • Added functionality includes: calculations for Access for Infants and Mothers (AIM); deemed eligibility for infants; enrollment for families with premium assistance into multiple plans; Medi-Cal plan selection

–       Service center performance goals: 80% of calls answered within 30 seconds, 5% or less of calls abandoned, 1% or less of calls receive busy signals

  • Between 9/3-9/17 (after ad campaign started airing in limited markets), received 11,000 calls and easily met all goals

–       Single streamlined paper application draft about 98% complete: total application package (including introductory material, privacy statements, optional questions, attachments and FAQs) is 33 pages, with 3 pages per individual

  • Web version will allow consumers to skip questions that are not relevant
  • Paper version available in 12 Medi-Cal threshold languages, written at 9th grade reading level

–       Quality rating system (QRS): no QRS information displayed at beginning of open enrollment, aiming for January 1, but questions remain on how to implement a system that accurately rates the quality of Covered CA provider networks, since many Exchange plans have very different networks than those in existence now

–       Supplemental vision policy: staff considering three options for supplemental vision plans for adults, but leaning towards a vision referral site overseen by an agency such as the Office of the Patient Advocate (no active purchasing, but could be ready to go sooner than state-hosted vision exchange with active purchasing, which would require legislative action to form a new entity)

–       Member level split family benefits (i.e. families with household members in different level/tier plans): CalHEERS can enroll non-subsidy families in separate plans/tiers, but starting Oct 1, will not have the functionality to allocate premium subsidies among family members in different plans/tiers

–       Grace period for premium payment by enrollees who are delinquent: to reconcile state and federal laws while protecting insurance plans from financial liability, state grace period is 1 month, with suspended coverage during months two and three of federal grace period

  • Enrollee can reinstate coverage by paying full premium due before last day of third month; if coverage reinstated, plan pays claims for covered services incurred during those two months
  • Providers are not obligated to provide care under contract with plan during second and third months when coverage is suspended and enrollee can pay providers directly if they so choose
  • Enrollees cannot re-enroll after 3 month grace period is exhausted and no payments are made; partial payment does not reinstate coverage

–       Premium payment policy

  • In-person and/or money order payment options being considered for the unbanked

–       Board approved regulations on:

  • Eligibility and enrollment: accessibility and readability standards; application and eligibility determination processes (including verification, redetermination, open enrollment, termination of coverage); appeals process
  • SHOP: reconciling state and federal laws (largely follows state law on the small group market, and only deviates in rare instances where federal law imposes requirements that do not exist in state laws); privacy considerations
  • Agent regulations and agreement: agent certification process; CalHEERS terms and conditions; training standards and policies
  • Plan-based enrollment regulations: creates pathway for consumer enrollment assistance to be provided by health plans

All meeting materials are available online.

Tags: , , , , , ,