Connecticut Department of Social Services Prospectus: Health Care Contracting Opportunities Charter Oak – HUSKY A – HUSKY B October 2007 M. Jodi Rell, Governor Michael P. Starkowski, Commissioner
Transcript
Slide 1
Connecticut Department of Social Services Prospectus: Health
Care Contracting Opportunities Charter Oak HUSKY A HUSKY B October
2007 M. Jodi Rell, Governor Michael P. Starkowski,
Commissioner
Slide 2
Connecticut Department of Social Services DSS Prospectus 1
Prospectus - Table of Contents Section Page Introduction 4 n
Purpose 5 n Opportunity 7 n HUSKY A/B/Plus 9 n Charter Oak11 n
Procurement14 n Timeline16 n Process18 n Rate Setting21 Section
Page 10. Program Design27 11. Target Population37 12. Benefits52
13. Network56 14. Becoming an MCO60 15. Sample Contracts64 16.
Appendices66 a) Websites67 b) Sample RFP Library68 17. Contact
Info69
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Connecticut Department of Social Services DSS Prospectus 2 My
goal is to make sure that every adult and child in Connecticut has
access to health insurance. Governor M. Jodi Rell (December 27,
2006)
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Connecticut Department of Social Services DSS Prospectus 3
Introduction: DSS to Release RFP in November 2007 n Connecticut
Department of Social Services (DSS) anticipates releasing a Request
For Proposal (RFP) in November 2007 for qualified carriers and
managed care organizations to provide health care services to the
combined HUSKY and Charter Oak programs n This prospectus is
intended to provide interested parties with background information
about the upcoming opportunity to win a contract under DSSs
competitive procurement to provide health care services to an
estimated 350,000 Connecticut citizens
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Connecticut Department of Social Services DSS Prospectus 4 1.
PURPOSE
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Connecticut Department of Social Services DSS Prospectus 5
Purpose: Competitively Procure Health Care Contracts July 1, 2008 n
Section 23 of Public Act 07-02 (June Special Session) authorized
DSS to enter into contracts with carriers and managed care
organizations effective July 1, 2008, to provide services for the
newly created state- sponsored health coverage program known as the
Charter Oak Health Plan Charter Oak, designed to provide premium
assistance in the form of premium subsidies to uninsured adults,
with incomes up to 300% of the federal poverty level (FPL), is one
piece of the states commitment to provide universal access to
affordable health insurance for Connecticut adults of all incomes n
DSSs existing managed care programs, HUSKY A & HUSKY B, have
approximately 320,000 covered lives. DSS will enter into new
contracts with carriers and managed care organizations, effective
July 1, 2008
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Connecticut Department of Social Services DSS Prospectus 6 2.
OPPORTUNITY
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Connecticut Department of Social Services DSS Prospectus 7
Opportunity: Combined HUSKY/Charter Oak Procurement n A combined
procurement for HUSKY and Charter Oak will cover an estimated
350,000 Connecticut citizens for a period of at least 3 years and
up to 5 years, with a total contract value projected to be in
excess of $3.5 billion over the five-year contract n Successful
bidders will be required to meet the network, operational,
contractual, and financial standards as laid out in the RFP and
provide services for both HUSKY programs, as well as the Charter
Oak program n All 350,000 lives will potentially be available under
this new contract. New contractors will have the opportunity to
enroll individuals and families through an initial open enrollment
period and receive newly eligible individuals and families
Slide 9
Connecticut Department of Social Services DSS Prospectus 8 3.
HUSKY A HUSKY B/HUSKY PLUS
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Connecticut Department of Social Services DSS Prospectus 9 DSS
Health Care Programs: HUSKY Plan n HUSKY A Comprehensive health
care coverage serving low-income children, parents, relative
caregivers with incomes up to 185% of FPL Includes pregnant women
with incomes up to 250% of FPL Traditional Medicaid health coverage
n HUSKY B Health coverage for uninsured children in moderate and
higher income families, 185% - 300% of FPL (unsubsidized group rate
coverage over 300% of FPL) n HUSKY Plus A supplemental program for
children with special medical needs available to participants
enrolled in HUSKY B (185% -300% of FPL). HUSKY Plus benefits are
paid on a feefor-service basis through DSS contracts
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Connecticut Department of Social Services DSS Prospectus 10 4.
CHARTER OAK HEALTH PLAN
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Connecticut Department of Social Services DSS Prospectus 11 DSS
Health Care Programs: Charter Oak Health Plan n Charter Oak is
designed to provide an affordable health insurance product to
adults of all incomes at a target total premium of $250 per member
per month n Charter Oak is not Medicaid: benefits will be based on
a commercial model, with enforceable deductibles, co-pays, and
coinsurance n For individuals with incomes less than 300% of FPL,
premium will be subsidized by the state according to a fixed
sliding scale
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Connecticut Department of Social Services DSS Prospectus 12
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
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Connecticut Department of Social Services DSS Prospectus 13 5.
PROCUREMENT
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Connecticut Department of Social Services DSS Prospectus 14
Procurement: Combined to Balance Risk and Simplify Administration n
DSS will release a Request for Proposals for the combined HUSKY A,
HUSKY B and Charter Oak programs in November 2007 n DSS is
combining the procurement to allow the successful bidders to
balance the familiar risk and large size of the HUSKY enrollment
with the less familiar and less predictable size of the Charter Oak
enrollment n DSS has a long, proven track record, having
administered Medicaid Managed Care since 1995, and the HUSKY Plan
(A/B) since 1998. Using this established infrastructure will allow
for simplified administration of the combined procurement and
reduce the risk to successful bidders by utilizing an existing,
known implementation process
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Connecticut Department of Social Services DSS Prospectus 15 6.
TIMELINE
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Connecticut Department of Social Services DSS Prospectus 16
Timeline: HUSKY/Charter Oak Procurement n Release of
ProspectusOctober 2007 n Release of RFPNovember 2007 n RFP Bidders
ConferenceDecember 2007 n RFP Bids DueJanuary 2008 n RFP
NegotiationsFebruary 2008 n RFP AwardsMarch 2008 n Open
EnrollmentMay 2008 n Contract Effective DateJuly 2008
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Connecticut Department of Social Services DSS Prospectus 17 7.
PROCESS
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Connecticut Department of Social Services DSS Prospectus 18
Process: Soliciting Feedback and Partnering n DSS is soliciting
feedback and interest from qualified carriers and managed care
organizations up to the release of the RFP in November 2007. Where
appropriate, DSS will incorporate the feedback into the RFP n DSS
will make the data available electronically used in the HUSKY rate
setting process to help interested parties more fully understand
the risk of the HUSKY program and assist in projecting risk of the
Charter Oak program n DSS will conduct a Bidders Conference and
will provide a question and answer process to allow interested
parties to interact with the States health policymakers and more
fully understand the HUSKY and Charter Oak programs
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Connecticut Department of Social Services DSS Prospectus 19
Process: Soliciting Feedback n Simultaneous with this prospectus,
the Department is finalizing the RFP for the combined HUSKY and
Charter Oak procurement. Per the attached timeline, DSS expects to
release the RFP within the next 30 days. To solicit comments on the
procurement prior to the RFP release, DSS has established the
[email protected][email protected] n Interested
parties should e-mail their comments to this mailbox. All comments
will reviewed by the Agency. Any comments requiring responses will
be sent to all interested parties that register by submitting an
e-mail labeled Request for Registration to the above mailbox
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Connecticut Department of Social Services DSS Prospectus 20 8.
RATE SETTING
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Connecticut Department of Social Services DSS Prospectus 21
Rate Setting Methodology: HUSKY A & HUSKY B n Rates required to
be Actuarially Sound per CMS Requirements n Rates set for State
Fiscal Year (SFY). Rates Effective July 1, 2008 will be in effect
for SFY09 (July 1, 2008, to July 1, 2009) n Rates are based on
Health Plan Financials and Encounter data, adjusted for:
Demographics Unpaid Claims Liability Program Changes Trend
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Connecticut Department of Social Services DSS Prospectus 22
Rate Setting Methodology Changes: Under Consideration HUSKY A &
HUSKY B n January 1, 2008 Maternity and newborn kick payments n
Future Rate Years - Changes Under Consideration Risk-Adjusted Rates
Pay-for-Performance Incentives Minimum Loss-Ratio Standards
Quality/Evidence-Based Payment Incentives
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Connecticut Department of Social Services DSS Prospectus 23
Rate Setting Methodology: Charter Oak n Rates will be Actuarially
Sound and able to meet CMS Requirements n Rates will be set for
State Fiscal Year (SFY). Rates Effective July 1, 2008 will be in
effect for SFY09 (July 1, 2008 to July 1, 2009) n Rates will be
based on HUSKY A adults data, adjusted for differences in:
Demographics Plan Design Underlying Risk/Acuity Reimbursement
Trend
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Connecticut Department of Social Services DSS Prospectus 24
Rate Setting Methodology: Charter Oak n Incentives/Sanctions DSS is
considering placing funds at-risk for contractor performance
standards in several areas, including: Geographic distribution of
key provider types for overall network access requirements
Availability of scheduled appointments for primary care and
specialty physicians for meeting appointment scheduling waiting
standards Telephonic wait times, call abandonment and resolution
rates for member and provider customer service standards Claims
adjudication times for meeting claims payment timeliness
requirements
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Connecticut Department of Social Services DSS Prospectus 25
HUSKY A Actuarially-sound Fiscal Year 2005 2007 Capitation Rates
HUSKY A Fiscal Year Rates AgeFY05* FY06* (First Half) FY06**
(Second Half)FY07**