Home » Blog » November Covered California Board Meeting: Plan Cancellation Conversion Policy, Pediatric Dental Benefits

November Covered California Board Meeting: Plan Cancellation Conversion Policy, Pediatric Dental Benefits

In the Executive Director’s report, Peter Lee noted that California not hampered by problems that the federal exchange (healthcare.gov) is facing.  In fact, Covered California has seen enrollment numbers improve in recent weeks. Some highlights:

  • As of November 19, 360,000 individuals determined eligible for coverage in either Medi-Cal or Covered California
  • combining enrollment in low income health programs (LIHP), almost 1 million Californians currently found to be eligible for ACA coverage expansions
  • last week averaged more than 10,000 individual applications completed per day
  • 73% of those who picked a plan through Covered California said it was easy to do so
  • young people (under 35) are enrolling at the same rate as the general population
  • 26% of enrollees are Spanish speakers
  • 60% of certified enrollment counselors (CECs) and over 13% of licensed insurance agents speak Spanish

Plan Cancellation Conversion Policy

To accommodate individuals/families who were facing plan cancellations because their plans were not grandfathered, President Obama announced that insurers have the option to offer renewals to consumers in non-compliant plans who were enrolled on October 1, 2013.  The implementation of this new transition policy has been left up to the states, and is subject to state law.

So what will California do?

After considering three options, the board voted to not allow the extension of such plans, but extend the enrollment period for conversion and allow for enrollment by 12/23/2013, with payment due by 1/5/2014. Other adopted policies include:

  • Implement a Covered California hotline with a dedicated unit of specially trained service center representatives to address consumer concerns about potential premium increases.  This hotline will be available starting 11/25/2013 at 1-855-857-0445 (Monday – Friday, 8am -8pm)
  • Partner with health plans to coordinate an additional 1.1 million co-branded notices to all eligible individuals informing them of their options
  • Collect and report data on a regular basis on conversion consumers, and report to Congress and the White House on the affordability for all consumers impacted

Extending these plans through 2014 could destabilize the market, increase confusion for consumers with inconsistent rules and varying benefits, and risk even steeper premium changes in 2015. For more details, read our previous blog post on the news.

Pediatric Dental Plans in 2015

Staff presented updated recommendations for standalone pediatric dental (SAPD) plans in 2015:

  • Option A: change (or receive a waiver) CMS regulations to add second lowest 70% standalone dental premium for calculating the advanced premium tax credit (APTC), and screen for pedi-dental plan purchase at checkout
  • Option B: work with issuers to offer a 10.0 embedded essential health benefits plan (i.e. covers all 10 of the benefits in one plan), and 0.5 dental plans (i.e. standalone dental plan for children)
    • Require dental-only deductible
    • Require protected dental out-of-pocket maximums, where possible
    • Require single out-of-pocket maximum for high deductible plans (including catastrophic plans)
    • Consider changing age curve to eliminate cross subsidization of embedded pediatric dental benefit, as the costs currently fall on adults, regardless if they have children or not
  • Option C: solicit both embedded 10.0 plans, as well as 9.5 plans (i.e. everything but pediatric dental) plans, except for the silver level which will be 10.0 plans only. Screen for pedi-dental plan purchase at checkout

Staff recommended Option B, while dental plans voiced concerns over an embedded plan; the California Association of Dental Plans urged Covered California staff to look at the successes in Nevada and Kentucky, both of which mandate the purchase of dental benefits, and offer both 10.0 and 9.5 plans.

Revised recommendations will be presented later this year, with the board taking action in December.

Board Action

The following staff recommendations were adopted by the board:

Identity proofing policy

  • Proposed revision to policy:
    • Online/phone applicants will respond to Remote Identity Proofing RIDP) supplied questions to verify identities (CalHEERS interface with federal data services hub)
    • Ways to verify identity:
      • Paper application – signature under the penalty of perjury
      • In-person – verify through review of photo documentation or other acceptable proof
      • Non-paper application – Federal Data Services Hub Remote Identity Proofing Process or in-person proof of identity or mail/electronic transmission of proof of identity

SHOP appeals process

  • Proposed appeals regulations
    • Employer/employee can appeal eligibility determination or failure to make one; or failure of the SHOP to provide written notice of an employer’s eligibility determination within 15 calendar days of receiving application
    • Employer/employee has 90 days to request appeal
    • Employer/employee shall have an informal resolution period
    • Appeals not resolved during the informal resolution will go to a formal hearing with the Department of Social Services
    • Appeals decisions will be issued to the appellant within 90 days of the appeal submittal date

Incompatible activities policy

  • Examples of incompatible activities for Covered California employees and officers:
    • Accepting a gift with the knowledge that it was given for the purpose of influencing official action
    • Directly or indirectly selling goods/services to Covered California
    • Maintaining a professional health care practice
    • Performing any act as a private citizen while knowing or having reason to know that act later will be subject to the employee’s review as a state official

Quality ratings system

  • Previously considered using a mix of quality rating systems (CAHPS, HEDIS), but based on staff and public recommendations, the staff explored using only CAHPS information for quality reporting in 2014
    • CAHPS information available for 9 of 11 issuers and 11 of 13 plans
      • Chinese Community or Valley Health Plans have no scores; no score to be posted for Alameda Alliance
      • Information available for all plans offered in 17 of 19 regions
  • Recommendation: use 10 CAHPS measures common to both commercial and Medi-Cal plans, a single summary score for each plan compared to the regional PPO benchmark, and a 1-4 star rating system
    • Earliest available presentation is January 2014
  • Other considerations:
    • Use single measure of overall rating of plan (like Colorado exchange); not feasible since measure is sensitive to type (HMO/PPO/Medi-Cal)
    • National vs. state benchmarks: insufficient number of plans at state level to be meaningful; national numbers masked known western region differences related to population served

The next board meeting, which will be the last before coverage expansions begin in January 2014, will be held in Sacramento on December 19, 2013. All meeting materials are available online.

Tags: , , ,