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Connecticut Department of Social Services. Health Care Contracting Opportunities Charter Oak – HUSKY A – HUSKY B Bidders’ Conference. February 22, 2008. M. Jodi Rell, Governor Michael P. Starkowski, Commissioner. AGENDA. Introduction Process Questions HUSKY Charter Oak.

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ConnecticutDepartment of Social Services

Health Care Contracting Opportunities

Charter Oak – HUSKY A – HUSKY B

Bidders’ Conference

February 22, 2008

M. Jodi Rell, Governor

Michael P. Starkowski, Commissioner


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AGENDA

  • Introduction

  • Process

  • Questions

  • HUSKY

  • Charter Oak


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HUSKYCost Proposal Requirements

  • Submit eight hardcopies and two electronic copies

  • Includes CRCS forms for each rating category (7 for HUSKY A, 3 for HUSKY B plus Charter Oak)

  • Supplemental newborn and maternity information for HUSKY

  • Supporting narrative detailing assumptions for bid preparation – separate for HUSKY and Charter Oak

  • Schedule 1: Certification statement – applies to both HUSKY and Charter Oak

  • Schedule 2: HUSKY and Charter Oak administrative cost detail

  • Schedule 3: HUSKY and Charter Oak supplemental information on capitated risk arrangements


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HUSKY CRCS Sheet


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HUSKYProgram Changes

  • DSS has implemented a number of recent program changes that bidders will need to consider

  • Change in eligibility for pregnant women

  • Increase in the Medicaid fee schedule for hospitals, clinics, physicians and vision

  • Implementation of Medicaid floor

  • Carve out of pharmacy and dental services


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HUSKY Rate Negotiation Process

  • Final HUSKY rates are required to be actuarially sound per CMS regulations

  • Mercer to determine actuarially sound rate ranges prior to bid submissions

  • Rates submitted outside of the actuarially sound rate range will receive counter “offer rate” from DSS

  • If necessary, negotiations will be conducted to ensure final rates are within the actuarially sound rate range.


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Bidders’ Library

  • HUSKY A historical eligibility and encounter data available upon request

  • Only HUSKY A encounter data available. No encounter data available for HUSKY B

  • Due to data limitations, encounter data service categories more limited than those requested in CRCS

  • Bidders encouraged to use own information to supplement data in bidders’ library


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Charter Oak Cost Proposal Requirements

Process

  • Submit eight hardcopies and two electronic copies

  • Includes CRCS forms for Base RFP Plan Design and, if necessary, alternative Plan Design rating category

  • Supporting narrative detailing assumptions for bid preparation – separate for HUSKY and Charter Oak


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Charter Oak Cost Proposal Requirements

Highlights

  • Two-Tier Rate Structure

  • Community Rated with Individual Target Premium of $250, regardless of age, sex, or geography for individuals with Incomes Above 300% FPL

  • Ability to Adjust Rates for Individuals with Incomes Below 300% FPL by FPL Band

  • MCOs not at risk for BH and Rx, but those services included within $250 Target Premium

  • Note: BH subject to limitations


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Charter OakFPL Table and Projected Enrollment

Total Cost of Monthly Premium


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Charter OakProgram Design

  • Geographic Area

    • Statewide Status: Anticipated Carriers will offer Coverage Statewide

  • Program Structure

    • State Program*: July 1, 2008

  • Authority

    • Section 23 of Public Act 07-02 (June Special Session)

  • Type of Enrollment

    • Voluntary, Affordable Health Insurance

      • Individuals without health insurance for the last six months or those who meet certain qualifying criteria to exempt them from uninsurance requirement

    • Excluded Populations

      • Individuals currently insured or insured within last six months (exemptions to be determined)

      • Individuals eligible but not enrolled in Public Programs (SAGA, HUSKY A and B, etc)

* DSS anticipates submitting a waiver to the Connecticut Legislature, and if approved, to CMS for Federal financial participation in portions of Charter Oak


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Deductible

Varies by FPL

Co-insurance

Varies by service

Out of Pocket Maximum

Varies by FPL

Lifetime Benefit Maximum

$1,000,000

Premiums by enrollee

*Maximum $250/month

Varies based on income

Primary Care Physician Visits

$25 co-pay

Specialist Physician Visits

$35 co-pay

Preventive Care

No co-pay, 100% covered

Inpatient Hospital

10% Co-insurance

Outpatient Surgical Facility

20% Co-insurance

Ambulance/Transportation

100% Covered in emergencies

Rx - $7,500 Annual Limit

DME - $4,000 Annual Limit

Behavioral Health Services, Rx services carved-out and provided through DSS

Dental and Vision Services may be provided as optional riders by MCOs with separate premium assessment

Charter OakBasic Benefit Features

See Appendix C in RFP: Charter Oak Plan Design Summary Table for additional detail

* Includes aggregate cost for medical, behavioral health and Rx carve-out


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Charter Oak CRCS Sheet (Top)


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Charter Oak CRCS Sheet (Bottom)


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Charter OakRate Negotiation Process

  • Final Charter Oak rates are required to be actuarially sound per CMS regulations*

  • srHS to determine actuarially sound rate ranges prior to bid submissions

  • Rates submitted outside of the actuarially sound rate range will receive counter “offer rate” from DSS

  • If necessary, negotiations will be conducted to ensure final rates are within the actuarially sound rate range

* DSS anticipates submitting a waiver to the Connecticut Legislature, and if approved, to CMS for Federal financial participation in portions of Charter Oak


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