State Exchange Delays Decision on Model Health Plan Contract

Sacramento Business Journal by Kathy Robertson –
April 24, 2013:
The board at Covered California announced early in its meeting Tuesday plans to defer action on its proposed model health plan contract until next month — and then got an earful of testimony on what needs to be fixed.
The board at Covered California announced early in its meeting Tuesday plans to defer action on its proposed model health plan contract until next month — and then got an earful of testimony on what needs to be fixed.
Some of it was a push from consumers for more transparency and data collection; some of it was push-back by plans worried about cumbersome requirements.
Health plans have expressed concern about collecting sensitive enrollee information not currently required, such as race, ethnicity, sexual orientation, gender identity and disability status. Exchange staff says reducing health disparities is a key goal of the program and starting in 2015, the program will collect this data from enrollees on a voluntary basis.
“We’re concerned we’ll not be able to meet the requirements in time,” said Charles Bacchi, executive vice president at the California Association of Health Plans.
“We support staff’s desire to get demographic information from plans; we need baseline information to track care,” countered Betsy Imolz, a lobbyist for Consumers Union.
Another issue is the extent health plans must be language friendly to what’s expected to be a diverse group of new members. While early versions of the model contract imposed more extensive language requirements than state law, the latest version scales that back to current law with one exception: all key communication with enrollees and website information must be available in both English and Spanish.
That change brought approval from Bacchi.
Quality reporting requirements are another issue for health plans.
“This will require plans to build infrastructure, train people and embrace the appropriateness of the goal of why the information is collected,” said Bill Wehrle, a lobbyist for Kaiser Permanente.
Several speakers objected to exchange plans to require members in all insurance products to be assigned to a primary care physician. Non-HMO models do not require this, and current provider contracts for preferred provider organization and exclusive provider organization plans do not have these provisions.
Exchange staff have proposed a revision to encourage assignment of primary care physicians when applicable or required by a health plan, but make auto-assignment optional.
There’s also concern that Covered California will become a third insurance regulator.
Already, California is the only state in the nation to have two government agencies with oversight over health insurance. The California Department of Managed Health Care regulates HMOs, while the California Department of Insurance regulates traditional health insurance and some preferred provider organization plans.
The evolving health benefit exchange wants stricter rules in some areas to ensure access to care and viability of the program, raising concern that it will assume regulatory authority already delegated to other agencies or adopt policy that should be approved by the Legislature.
The latest language in the model plan contract would defer to state regulators in areas such as financial insolvency, credentialing and utilization review, but keep areas where the exchange is concerned about direct consumer impacts.
“There’s existing regulatory oversight,” said Deborah Kelch, a health policy expert with a grant from the California Health Care Foundation to do research and analysis on the issue via the Health Insurance Alignment Project. Pointing to licensing and quality standards at the Department of Insurance and Department of Managed Health Care, Kelch cautioned the board against causing “even further confusion in the marketplace.”
The board has scheduled a special meeting from 9 to noon May 7 to take final action on the proposed model health plan contract.

Source: John & Rusty Report via Choice Admin