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Covered California August Board Meeting

The end of summer is fast approaching and Covered California is in full gear preparing for its third open enrollment. Working diligently to ensure a seamless consumer shopping experience, Covered California has been successful in negotiating competitive rates, debuting new plans on the exchange and presenting the qualified health plans’ satisfaction ratings. Updates on the topics of Covered California’s small business side, navigator awardees, vision coverage and agent responsibility were also discussed at the meeting. Details of the August meeting can be found below.

New Appointee

Covered California welcomed new board member, Art Torres. California’s Senate Rules Committee appointed Torres to the position.

Covered California Plan Rates

As discussed in a previous ITUP blog, Covered California released their individual plan rates. The statewide increase was very modest at only 4.0%. Two new health plans, United and Oscar, will be offered for specific regions on the exchange. Blue Shield will now be available throughout the entire State instead of just select zip codes. Health Net and Molina will also be expanding to additional regions. With the addition of the two new health plans, 99.6% of consumers will have at least three health plan options and all Californians will have at least two health plan options. The majority (56%) of consumers who stay with their current plan will see a premium change of 5% or less with 20% of these consumers seeing a decrease in premiums. Overall, negotiations in 2016 have saved Californians over $200 million in premiums, including subsidies from the federal government.

A detailed breakdown of health plans and rates can be found in Covered California’s,“Health Insurance Companies and Plan rates for 2016.”

Health Plan Quality Reporting

Covered California has been utilizing the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey to help consumers make decisions based not on just health plan price, but also health plan quality. However up until now these survey results were based on the health plan’s commercial product lines. Starting in the upcoming 2015 open enrollment, the CAHPS results displayed will include ratings specifically from the qualified health plan (QHPs) products offered on Covered California. This is ahead of the Centers from Medicare and Medicaid Services (CMS) 2016 enforcement date for all exchanges to use QHP CAHPS survey results.

QHP CAHPS survey results have started to be reported. For example, seventy percent of survey responders were from individuals that have products from the exchange, seventeen percent were from individual’s off-exchange and thirteen percent were from Covered California Small Business. Additionally, the response rate of the survey was lower than expected, 21%, whereas response rates are usually around 30%. Due to this low response rate only a couple of satisfaction indicators can be used to report to consumers instead of the original 10 CAHPS questions. No clinical indicators will be available. The two indicators that will be reported are Rating of All Health Care and Rating of Health Plan. Despite the truncated number of quality indicators used, the two that will be used have been shown to capture the global rating of a health plan accurately.
Implementation of a five-star rating system was supposed to begin this year, but due to CalHEERS limitations this will be delayed a year. The four-star system will remain in place for now.

CMS only requires 1,000 enrollees from each QHP to describe their experience with the plan. This is a rather low sample of people, and advocates would like to see a larger sampling of people to have a better gauge of more nuanced quality indicators, such as results from specific sub-populations like LGBTQ consumers, etc.

Covered California for Small Business

As of July 2015, approximately 18,500 small business members are enrolled in Covered California for Small Businesses. Carrier payments are now automated. Automation of General Agent payments and Agent payments are forthcoming. Covered California has been working on these payment issues and is hopeful the agent experience will be much improved with automation.

Navigator Program

Covered California put out a competitive request for proposal (RFP) for the navigator program. A hundred-plus organizations applied for funding to reach, enroll, and re-enroll consumers. The award amounts to applicants were between $50,000 to $500,000, totaling $10.3 million. Los Angeles agencies had the highest number of applications awarded (25). The RFP emphasized outreach to minority and hard-to-reach populations such as Latino, Asian, African American and LGBTQ populations.

Enrollment Assistance Programs

Navigators will be compensated during the 2016 open enrollment, however enrollment counselors will not be compensated. Enrollment counselors are still required to be certified despite not receiving compensation.

Vision Coverage for Consumers

There was an update on the possibility of offering vision coverage on the Covered California website. Covered California has proposed adding a link to their website to direct shoppers to vision plans’ websites. Covered California cannot offer vision coverage directly on its site because it is not a QHP.

Covered California would enforce vendor requirements, including:
• Licensed in good standing, and
• Standard contract terms

In addition to the link on the website, Covered California would provide consumers with facts and information to assist them in buying vision coverage.

Due to the fact that no Covered California funds can be used to set up an exchange for vision or any other non-QHP plans, Covered California proposes an application, implementation and ongoing fee for the vision health plans interest. The proposed application fee is $1,000 and proposed implementation fee is $10,000. There are a few possible options for the structure of ongoing payments from the vision health plans. The options are 1) 10% first year only, 2) 5% first year and ongoing, and 3) other options such as a flat fee per new and/or continuing enrollees. Covered California will not be involved in standardizing benefits or assisting consumers with vision plans issues. Covered California must be transparent that they are not endorsing any of the vision plans.

There is potential in the future for California to have an active purchasing model and system integration for vision plans as it does with its QHPs, but these are far off visions for the future.

A proposed timeline for this vision plan process, should the Covered California board decide to continue to move forward with this initiative, was released:

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There is concern from advocates that because Covered California will not be standardizing benefits or assisting consumers with their issues and concerns the Covered California coveted image and trust from consumers could potentially be lost because they will be on their own for this coverage. More discussion amongst the board will be needed on this topic.

Agent Commission Level for Groups with 51+ Employees

Covered California will open to small businesses between 51-100 employees market starting on January 1, 2016. Agent commission for businesses with 51-100 employees was announced at 5%. There is no change to the commission for 1-50 employee groups. The recommendation is consistent with market standards.

Agent Responsibility for Medi-Cal Enrollment

There was also a discussion on agent responsibility for Medi-Cal enrollment. Currently, Covered California works with certified agents that are required to help individuals enroll in Medi-Cal. However, certified agents no longer get paid for Medi-Cal enrollment applications and are not as informed on the nuances of Medi-Cal coverage. Covered California is exploring the option of having certified agents refer applicants to County Eligibility Workers or other enrollers with more knowledge on the Medi-Cal process and benefits offered. There are pros and cons to both options with different advocates supporting each option. There will be a stakeholder meeting on August 28, 2015 to further discuss this topic and request for action on October 8, 2015.

Other Things Learned…:
• Open enrollment dates for 2016 are November 1, 2015 to January 31, 2016.
• Special enrollment period will now include victims of domestic abuse and spousal abandonment. This will be based on self-attestation.

The materials from the meeting are available at the Covered California website, available here. The next Covered California meeting will be October 8th.