Presentation is loading. Please wait.

Presentation is loading. Please wait.

Connecticut Department of Social Services Health Care Contracting Opportunities Charter Oak – HUSKY A – HUSKY B Bidders’ Conference February 22, 2008 M.

Similar presentations


Presentation on theme: "Connecticut Department of Social Services Health Care Contracting Opportunities Charter Oak – HUSKY A – HUSKY B Bidders’ Conference February 22, 2008 M."— Presentation transcript:

1 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

2 Connecticut Department of Social Services DSS Bidder’s Conference 1 AGENDA n Introduction n Process n Questions n HUSKY n Charter Oak

3 Connecticut Department of Social Services DSS Bidder’s Conference 2 HUSKY Cost Proposal Requirements n Submit eight hardcopies and two electronic copies n Includes CRCS forms for each rating category (7 for HUSKY A, 3 for HUSKY B plus Charter Oak) n Supplemental newborn and maternity information for HUSKY n Supporting narrative detailing assumptions for bid preparation – separate for HUSKY and Charter Oak n Schedule 1: Certification statement – applies to both HUSKY and Charter Oak n Schedule 2: HUSKY and Charter Oak administrative cost detail n Schedule 3: HUSKY and Charter Oak supplemental information on capitated risk arrangements

4 Connecticut Department of Social Services DSS Bidder’s Conference 3 HUSKY CRCS Sheet

5 Connecticut Department of Social Services DSS Bidder’s Conference 4 HUSKY Program Changes n DSS has implemented a number of recent program changes that bidders will need to consider n Change in eligibility for pregnant women n Increase in the Medicaid fee schedule for hospitals, clinics, physicians and vision n Implementation of Medicaid floor n Carve out of pharmacy and dental services

6 Connecticut Department of Social Services DSS Bidder’s Conference 5 HUSKY Rate Negotiation Process n Final HUSKY rates are required to be actuarially sound per CMS regulations n Mercer to determine actuarially sound rate ranges prior to bid submissions n Rates submitted outside of the actuarially sound rate range will receive counter “offer rate” from DSS n If necessary, negotiations will be conducted to ensure final rates are within the actuarially sound rate range.

7 Connecticut Department of Social Services DSS Bidder’s Conference 6 Bidders’ Library n HUSKY A historical eligibility and encounter data available upon request n Only HUSKY A encounter data available. No encounter data available for HUSKY B n Due to data limitations, encounter data service categories more limited than those requested in CRCS n Bidders encouraged to use own information to supplement data in bidders’ library

8 Connecticut Department of Social Services DSS Bidder’s Conference 7 Charter Oak Cost Proposal Requirements Process n Submit eight hardcopies and two electronic copies n Includes CRCS forms for Base RFP Plan Design and, if necessary, alternative Plan Design rating category n Supporting narrative detailing assumptions for bid preparation – separate for HUSKY and Charter Oak

9 Connecticut Department of Social Services DSS Bidder’s Conference 8 Charter Oak Cost Proposal Requirements Highlights n Two-Tier Rate Structure n Community Rated with Individual Target Premium of $250, regardless of age, sex, or geography for individuals with Incomes Above 300% FPL n Ability to Adjust Rates for Individuals with Incomes Below 300% FPL by FPL Band n MCOs not at risk for BH and Rx, but those services included within $250 Target Premium n Note: BH subject to limitations

10 Connecticut Department of Social Services DSS Bidder’s Conference 9 Charter Oak FPL Table and Projected Enrollment Total Cost of Monthly Premium Total Clients SFY09 Average 8,700 SFY10 Average 21,400 SFY11 Average 32,800

11 Connecticut Department of Social Services DSS Bidder’s Conference 10 Charter Oak Program Design n Geographic Area –Statewide Status: Anticipated Carriers will offer Coverage Statewide n Program Structure –State Program*: July 1, 2008 n Authority –Section 23 of Public Act (June Special Session) n 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

12 Connecticut Department of Social Services DSS Bidder’s Conference 11 Charter Oak Basic Benefit Features n Deductible –Varies by FPL n Co-insurance –Varies by service n Out of Pocket Maximum –Varies by FPL n Lifetime Benefit Maximum –$1,000,000 n Premiums by enrollee –*Maximum $250/month –Varies based on income n Primary Care Physician Visits –$25 co-pay n Specialist Physician Visits –$35 co-pay n Preventive Care –No co-pay, 100% covered n Inpatient Hospital –10% Co-insurance n Outpatient Surgical Facility –20% Co-insurance n Ambulance/Transportation –100% Covered in emergencies n Rx - $7,500 Annual Limit n DME - $4,000 Annual Limit n Behavioral Health Services, Rx services carved-out and provided through DSS n Dental and Vision Services may be provided as optional riders by MCOs with separate premium assessment 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

13 Connecticut Department of Social Services DSS Bidder’s Conference 12 Charter Oak CRCS Sheet (Top)

14 Connecticut Department of Social Services DSS Bidder’s Conference 13 Charter Oak CRCS Sheet (Bottom)

15 Connecticut Department of Social Services DSS Bidder’s Conference 14 Charter Oak Rate Negotiation Process n Final Charter Oak rates are required to be actuarially sound per CMS regulations* n srHS to determine actuarially sound rate ranges prior to bid submissions n Rates submitted outside of the actuarially sound rate range will receive counter “offer rate” from DSS n 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


Download ppt "Connecticut Department of Social Services Health Care Contracting Opportunities Charter Oak – HUSKY A – HUSKY B Bidders’ Conference February 22, 2008 M."

Similar presentations


Ads by Google