“Closing the Loop”

1. “Closing the Loop” Helping Districts Understand and Implement Codified Best Practices in Public School Health Plans

2. All districts must • Comply with statute • Ohio Revised Code • Section 9.901 • Comply with rules • Ohio Administrative Code • Sections 3306-2-01 through 3306-2-06

3. Closing the Loop • Understanding what your district has to do • Understanding when your district has to do it • Might want a translator...

4. Legalese • “All health care benefits • provided to persons employed by the school districts of this state • shall be provided by health care plans • that contain best practices established pursuant to this section by the school employees health care board.”

5. Translation • Districts must offer health plans that contain the four best practice standards adopted by SEHCB.

6. Legalese • “Twelve months after the release of best practices by the board • all policies or contracts for health care benefits provided to public school district employees • that are issued or renewed after the expiration of any applicable collective bargaining agreement • must contain best practices established pursuant to this section by the board.”

7. Translation • All policies or contracts for healthcare benefits which are • issued or renewed • after January 1, 2010 • at the expiration of a collective bargaining agreement • must contain the best practice standards.

8. Legalese • “Each health care plan sponsor • offering health care benefits • to persons employed with the public school districts of this state shall • furnish to the board evidence of its compliance with all best practices as established by this chapter.”

9. Translation • Districts must provide the SEHCB with evidence that health plans offered contain each of the best practice standards.

10. Legalese • “Each public school district shall file annually • on or before the first day of July • a written report, on a formprescribed by the board, which describes • the progress made to reduce the rate of increase in insurance premiums and employee out of pocket expenses and • the progress made to improve the health status of public school district employees and their allowable dependents. • The report shall also document the implementation of the best practice standards adopted by the public school district.”

11. Translation • Districts must file an annual written report • On or before July 1, 2010 • Describing efforts taken to • Reduce rate of premium increases • Reduce employee out of pocket expenses • Improve health status of employees and dependents • Implementation of best practices

12. SEHCB Responsibilities • Also set by statute or rule • Certify compliance • Review the annual status report received from each public school district • Prepare and disseminate an annual report to the public • Work with health plan sponsors through educational outlets and consultation

13. SEHCB Annual Report • The board shall prepare and disseminate to the public an annual report on: • the status of each health plan sponsors’ effectiveness in reducing the rate of increase in insurance premiums and employee out of pocket expenses and • the progress made to improve the health status of public school district employees and their allowable dependents.

14. Outstanding questions • Work in progress • Ambiguity • Nature and extent of review of plans and programs • Appropriateness of ‘bright line’ definitions to resolve ambiguities, establish uniformity regardless of district size or other factors • Information to be included in SEHCB annual report • Lots of other things...

15. The point • Collaborative process • Shared goals • Open, regular communication • Transparency • Common sense can and will prevail