Seeking nominations for CT thought leaders

We are refreshing our invitation list for the CT Health Thoughtleader Survey. The survey has been cited by policymakers as a tool in evaluating our state’s progress toward reform. It is part of our CT Health Reform Dashboard. To keep the list robust and ensure a broad reach, we are seeking nominations for the survey. Who do you rely on for information on health reform in CT? Help us improve the tools for our state’s health policymakers and give us your nominations.

Health Insurance Exchange Board recommends standards for benefit package

Last week, the CT Health Insurance Exchange Board voted on their recommendation for the benchmark essential health benefit (EHB) package that must be offered in 2014 by all individual and small group plans, both inside and outside the Exchange, under national health reform. Federal regulators granted states the ability to define the EHB package, within guidelines. The plan is modeled on ConnectiCare’s HMO package, with additions including coverage for prescription drugs and pediatric vision and dental care. The plan includes all state mandated benefits. Abortion coverage is included but must be paid with non-federal funds. The choice of ConnectiCare’s package was a compromise reached in two Exchange Advisory Committees in a contentious process. The plan represents the middle choice in generosity of benefits and price among the federal options. Thankfully, the Exchange Board honored the process of the two committees; advocates had been concerned that the insurance-dominated Board, that includes no independent consumer representatives, would choose a less generous option. The recommendation is now open to public comment for 30 days.

Walgreens Back With Anthem Blue Cross Sept 15th

Walgreens Pharmacy and Express Scripts have reached an agreement for Walgreens to participate as an in-network retail pharmacy.

Beginning September 15, 2012, Anthem Blue Cross members will be able to again use their pharmacy benefit at Walgreens.

This applies to individual & family plans, small and large group plans, Medicare and Medicaid (Medi-Cal) members.

This applies to all Walgreen pharmacies as well as Happy Harry's and Duane Reade pharmacies owned by Walgreens.

Dave
www.davefluker.com

CA SB 1431 Update (July 24) Stop-Loss Coverage

Just wanted to post a further update to SB 1431 which deals with small group (2-50 employees) in California using "stop-loss" or self-funded health plans.

Last week the bill passed Assembly with some revisions to stop-loss numbers. I mentioned in a previous blog ( CA SB 1431 Update (May 21) that some changes were being considered for this Bill.

The current version of CA SB 1431 has the following changes:

*Per employee deductible reduced from the original $95,000 to $60,000 (per employee and per dependent)

*Attachment Point for group stop-loss set at 135% of expected claims for the group

I will advise if and when SB 1431 is passed or not passed into law.

Dave
www.davefluker.com

Exchange Navigator Committee moves into recommendations

Yesterday the CT Health Insurance Exchange Brokers, Agents, and Navigators Committee started the hard work of developing a structure and defining roles for the Navigator Program. Navigators will educate and help enroll potential individual and small business exchange, and Medicaid enrollees. Under the ACA and federal regulations, navigators must have demonstrated ability to reach those three audiences, meet licensure and conflict of interest standards (yet to be determined), and meet certification standards set by the Exchange (also yet to be determined). Staff draft recommendations include two tiers of navigators. Tier 1 Educators will focus on raising awareness of the Exchange and Medicaid options, distribute impartial information about options and enrollment, and ensure cultural competence. They would be paid on a grant/lump sum basis. Tier 2 Enrollers will focus on collecting the information needed to determine eligibility for appropriate programs, assisting in enrollment, and follow up. The committee is still discussing how to compensate Tier 2 navigators. Organizations, not individuals, will be designated as navigators and can apply for Tier 1, Tier 2 or both functions, but individuals acting as navigators will have to receive the appropriate training and certifications. The committee is still discussing how to certify SHOP navigators. The committee also discussed providing training/information opportunities for stakeholder organizations and individuals who are not interested in certifying, or being paid, as navigators but want to help in outreach and public education.

The committee also reviewed new data from Thompson Reuters commissioned for the exchange on CT’s uninsured, Medicaid and likely exchange-eligible populations to help target outreach and education efforts. Initial analysis found that current uninsured and Medicaid populations live in the same communities, and a small number of urban zip codes, particularly in Hartford and New Haven, account for a significant part of both populations. Researchers estimate that there are currently 66,000 adults and 18,000 children in CT eligible for the current Medicaid program but not enrolled. They also estimate that 205,000 adults and 11,000 children will be eligible for subsidies in the exchange. There is a lot of information on citizenship, race/ethnicity, income levels, and the proportion having difficulty speaking English.

Medicare Part B Premium To Jump To $247 Per Month in 2014! (Hoax)

One thing I love about these "internets" is the birth and propagation of urban legends. The one I am seeing most right now in the health insurance community is as follows:

Italicized in brackets are my comments.

"The per person Medicare insurance premium [Part B] will increase from the present fee of $96.40 [this was the 2009 rate by the way] to $104.20 in 2012, $120.20 in 2013, and $247 in 2014. These are provisions incorporated in the Obamacare legislation [PPACA] purposely delayed so as not to confuse the 2012 re-election campaign. Send this to all seniors that you know so they will know who is throwing them under the bus. Obama knows that this will kill his chances for a second term if enacted now and he thinks voters are stupid and won't know or care about anything that doesn't affect them now. REMEMBER THIS IN NOVEMBER AND VOTE ACCORDINGLY"

If you receive this information it is a hoax and urban legend that will likely continue to make the rounds at least through the 2012 Presidential election. I am sure there are some variations going around as well.

I wanted to warn seniors in California (and other states) that there is no factual basis for this hoax and it is a political scare tactic with no truth.

Snopes has a great explanation of this urban legend so I won't replicate it here. Click on the link below to read an excellent summary:

Snopes.com: Medicare Premium Increases

If I ever receive factual information about such a rate change on any health plan (Medicare or otherwise) in California, I will let you know here on my blog.

Dave
www.davefluker.com

California Insurance Commissioner vs Blue Shield CA (Follow Up)

I wanted to post a follow up to my earlier BLOG of July 3rd concerning California Insurance Commissioner Dave Jones disapproval of the Blue Shield Life & Health CDI plan closures.

I spoke with Blue Shield today and we are pending official notification from the insurance company in regard to Mr. Jones' announcement. I will provide information via a new BLOG post once I have it.

In the meantime I wanted to provide a link to the CDI web site and Dave Jones official press release regarding this issue. The official announcement provides a more detailed explanation of the decision.

Dave Jones Blue Shield Press Release

Dave
www.davefluker.com

CA Insurance Commissioner Disapproves Blue Shield CA Plan Closures

California Insurance Commissioner Dave Jones announced today that he has disapproved the announced health plan closures by Blue Shield Life & Health. See my previous blog "Blue Shield To Close and Replace Most Individual Health Plans in California" from April 17th.

The CDI (CA Dept of Insurance)originally disapproved the plan closures in March, 2012, and requested additional information be provided by Blue Shield by June. The CDI reviewed the information and sustained the disapproval of the plan closures citing a lack of size of the remaining open block for pooling so as not to create a "death spiral" with the closed block.

All of Blue Shield's new PPO plans are registered with the CA Dept of Managed Healthcare (DMHC) leaving only one PPO plan from Blue Shield Life & Health.

Additionally the Commissioner notes that one specific health plan, the Vital Shield 2900 PPO has insufficient provision for 20,000 members as it offers no plan transfer right without medical underwriting.

I have yet to receive anything from Blue Shield CA regarding this decision by the CDI and will advise as soon as I receive any information from them. Until then, the closed plans are not available to new health insurance purchasers in California.

Dave
www.davefluker.com

The Game’s Not Over, and It May Not Even Be The Real Game

by Brian Klepper

Like most health law watchers, I was surprised by the recent Supreme Court decision. I'm sure that on this issue, as with everything else, zealous responses rationalize the result and split the country down the middle.

I expected the Court to be purely partisan, but apparently Chief Justice John Roberts, acknowledging the gravity of his role, saw his way clear to support the

CT Health Intern conference July 24th

Breaking into Health: Tapping into Skills and Experience, is designed for anyone interested in breaking into CT’s health landscape to gain valuable skills from health professionals working in the real world of health care and policy. The free conference will be July 24th from 10am to 4pm at the Divinity School at Yale, is co-sponsored by the CT Health Policy Project and Dwight Hall at Yale. Speakers include Comptroller Kevin Lembo as well as reporters, business people, state agency staff, foundations, health care providers, advocates, and budget analysts. Parking and lunch are free but registration is limited. For more information and to register, go to www.cthealthintern.org.

The ACA and what it means for CT consumers and small business

While we are all celebrating the Supreme Court upholding the Affordable Care Act, consumers and small businesses want to know what it means in the real world. The CT Health I-Team has a great piece answering just that question.