DMHC Update CAHP Conference 2017

Transcription

1 DMHC Update CAHP Conference 2017 Presented by: Shelley Rouillard, Director Marta Green, Chief Deputy Director Jenny Phillips, Legislative Affairs Deputy Director Mary Watanabe, Health Policy and Stakeholder Relations Deputy Director October 11,

2 DMHC Mission To protect consumers health care rights and ensure a stable health care delivery system 2

3 Our Accomplishments December

4 DMHC Priorities Provider Directories Timely Access to Care Clinical Quality Improvement 4

5 Provider Directories California Healthline January 26, 2015 Los Angeles Times February 4, 2014 Retrieved from Retrieved from 5

6 Provider Directories SB 137 (Hernandez) Set standards for provider directories Uniform Provider Directory Standards Released December 31, 2016 Compliance date January 1, 2018 Final Regulations January 1, 2021 Provider Directory Utility 6

7 Timely Access to Care MY 2015 Challenges MY 2016 Report MY 2017 Data Collection MY 2018 Improvements 7

8 Clinical Quality Improvement Chief Medical Officer Merger Undertakings Encounter Data 8

9 Our Leadership 9

10 Employees Employees Budget Our Growth Budget (in millions)

11 DMHC Enrollment Over Time 11

12 Market Changes: HMO vs PPO/EPO PPO/EPO HMO In millions

13 Premium Rate Review Website 13

14 14

15 15

16 Notifications 16

17 Rulemaking Risk and Restricted License Regulations AB 72 (Bonta, 2016) Average Contracted Rates (ACR) Regulations and Independent Dispute Resolution Process (IDRP) SB 137 (Hernandez, 2015) Provider Directories SB 1052 (Torres, 2015) Standard Drug Formulary Template 17

18 2017 Enacted Bills Summary AB 156 (Wood) Open Enrollment AB 1048 (Arambula) Schedule II Partial Fills AB 1074 (Maienschein) Behavioral Health Therapy Providers SB 17 (Hernandez) Prescription Drug Costs SB 133 (Hernandez) Continuity of Care 18

19 AB 156 (Wood) Open Enrollment Sets the open enrollment periods for individual coverage starting in 2019 as follows: On Exchange Enrollment Window Special Enrollment October 15, 2018 to October 31, 2018 Open Enrollment November 1, 2018 to December 15, 2018 Special Enrollment December 16, 2018 to January 15, 2019 Off Exchange Enrollment Window Open Enrollment October 15, 2018 to January 15,

20 AB 1048 (Arambula) Schedule II Partial Fills Pharmacists may dispense opioids as a partial fill (less than entire prescription) if requested by a patient or prescriber Effective July 1, 2018 Health plans must prorate a patient s cost sharing for a partial fill Effective January 1,

21 AB 1074 (Maienschein) Behavioral Health Therapy Providers Effective January 1, 2018 Clarifies that Qualified Autism Service (QAS) Professionals and Paraprofessionals may be employed by a qualified entity or group Deletes requirement that QAS Professionals be vendored by a Regional Center Permits QAS Professionals to supervise Paraprofessionals when appropriate 21

22 SB 17 (Hernandez) Prescription Drug Costs Health plans must report to the DMHC: 25 most frequently prescribed drugs 25 most costly drugs by total annual spending 25 drugs with highest year-over-year increase in total annual spending Health plans must report by October 1, 2018 and annually thereafter DMHC will issue report to Legislature with aggregate data beginning January 1, 2019 and annually thereafter 22

23 SB 17 (Hernandez) Prescription Drug Costs Additional reporting requirements for large group market: Percent of premium attributable to drug costs for each category of prescription drugs (e.g., generic, brand name, and brand name/generic specialty) Year-over-year increase, as a percentage, in per member, per month costs for each category Year-over-year increase in per member, per month costs for drug prices compared to other components of the health care premium Specialty tier formulary list Percentage of the premium attributable to prescription drugs administered in a doctor s office that are covered under the medical benefit as separate from the pharmacy benefit, if available Information on use of a pharmacy benefit manager, if any, including which components of prescription drug coverage are managed by the pharmacy benefit manager 23

24 SB 17 (Hernandez) Prescription Drug Costs Reporting requirements for drug manufacturers to public/private purchasers, effective January 1, 2018: For drugs with a wholesale acquisition cost over $40 for a course of treatment, must report if cumulative increase is more than 16% over prior two calendar years Effective January 1, 2019, requires drug manufacturers to report increases in wholesale acquisition cost and other details to OSHPD OSHPD will publish this information on its website at least quarterly OSHPD will be funded by health plan assessments, to be offset by penalty revenue for non-compliance with reporting requirements 24

25 SB 133 (Hernandez) Continuity of Care Effective January 1, 2018 Expands existing continuity of care protections to patients in the individual market when their health plan withdraws from the market Termination of coverage notice when health plan withdraws from the market must include information about continuity of care 25

26 Questions or Comments? 26