ALASKA COMPREHENSIVE HEALTH INSURANCE ASSOCIATION TELECONFERENCE MEETING OF THE BOARD OF DIRECTORS

Transcription

1 ALASKA TELECONFERENCE MEETING OF THE BOARD OF DIRECTORS Tuesday, February 25, :00 Eastern, 1:00 Central, 11:00 Pacific, 10:00 Alaska Meeting Call to Order The teleconference meeting of the Alaska Comprehensive Health Insurance Association was called to order by Jeff Davis, Chair, at 10:10 a.m. Alaska time on Tuesday, February 25, Board Members Present: Jeff Davis, Chair Brian Angel, Vice Chair Katie Campbell (Ex-Officio) Chet Lozowski Mona McAleese Shawn Pollock Premera Blue Cross & Blue Shield of Alaska AFLAC Division of Insurance Continental General Insurance Company Public Advocate Mutual of Omaha Insurance Company Board Members Absent: David Hill Marilyn Kasmar Assurant Health Public Advocate Others Present: Cecil Bykerk, Executive Director Shauna Nickel Debbie McCormick Bernie Jamieson Janet Oates Cindy Carl C.D. Bykerk Consulting, LLC Department of Insurance BMI Administrator BMI Administrator Media Relations Recorder 1. Review agenda There were no changes to the agenda, and it was adopted by unanimous consent. 2. Review minutes Approval of minutes 6/26 (2), 6/27, 10/28, 11/7, 11/25 MOTION BY: MONA to approve the following sets of minutes: SECOND BY: SHAWN (1) June 26, 2013 annual Board of Directors meeting; PASSSED UNANIMOUSLY (2) June 26, 2013 Public Comment portion of the annual meeting; (3) June 27, 2013 annual Board of Directors meeting; (4) October 28, 2013 teleconference regular meeting; (5) November 7, 2013 teleconference special meeting; and (6) November 25, 2013 teleconference regular meeting.

2 Tuesday, February 25, 2014 Page 2 of 5 3. Executive Director Report & Comments Cecil - Federal Grant Program Cecil Cecil reported that after conducting business on Continuing Resolutions for years, Congress had finally passed the first full budget in a number of years. Part of the appropriations included $22 million for the federal grant program, which was half what was approved in prior years because not as much money was needed to fund the program at this point. Cecil said that NASCHIP has had a couple of calls with CCIIO, and there was a discussion yesterday with Kevin Simpson regarding the grant program. He said it was determined that the regular grant program would continue to be allocated two-thirds and the bonus grant program one-third of the funds, and ACHIA would be receiving both grant and bonus grant funds. He said it was still unknown how many pools were left that would receive the bonus grants, but since there were fewer now than there were at the inception of the bonus grant program, it was possible that ACHIA may receive a similar amount of money as it had in prior years. 4. Report from Administrator Debbie/Bernie/Denise - Administrative & Service Reports for ACHIA Debbie reviewed the ACHIA Operations Report as of January 31, 2014, including levels of service, number of claims received monthly as compared to the previous year, service code analysis report for the month of January 2014, the top provider report for January, the claims lag report using incurred dates and showing dollars, the average cost per claim paid for Non- Medicare and Medicare plans, the PPO savings from February 2013 through January 2014, and the high-dollar paid claims report. Debbie reviewed the plan and age distribution summary and the enrollment activity from February 2013 through January Debbie responded to questions regarding the declining enrollment numbers then continued with the enrollment activity over all ACHIA plans, broken out by Medicare and non-medicare plans, as reported on pages 12 and 13. She said that all enrollment numbers had decreased, including enrollment in the Medicare Carveout and Med Supp plans. Reviewing the enrollment activity chart on Page 14, Debbie reported that 4 new members were enrolled in January and 146 terminated, for a net loss of 142. She reviewed where the new enrollees had come from and the reasons for termination, as well as top insurance producers. Jeff commented on the decline in the enrollment figures, and Debbie said that BMI had seen consistent declines in all of BMI's state pools that were still in operation today. Discussion was heard. Jeff asked if it would be possible to track deductible levels and ages of new enrollees, and Debbie said they could do that. She said she would send the request to premium billing and enrollment. - Financial Reports Bernie reviewed with the Board the cash flow statement, including the premium deposits and claims for January 31, He said they started out January with $9.5 million and ended January with 8.5 million, which was about $1.5 million less than they had for the same time period last year.

3 Tuesday, February 25, 2014 Page 3 of 5 - Administrative & Service Reports for ACHIA-FED Debbie recapped the January 2014 ACHIA-FED operations report, including levels of service for January She explained that there has been a higher volume of calls and the calls were of longer duration as people were trying to get information about what was available under ACHIA and ACHIA-FED, determine what their options were, and get guidance in making their health care coverage decisions. She said BMI was making its best effort to provide their enrollees and the public the best customer service possible and assist them with the guidance they need going forward. Jeff said that in light of the transition difficulties experienced thus far, BMI had done very well under the circumstances. Debbie gave an overview of the number of claims received from February 2013 through January 2014 as compared to the previous year, and noted a decline trending in claims. She summarized the service code analysis report, the top provider report, the claims lag report using incurred and showing dollars, and the average cost per claim paid for January She also recapped the PPO savings analysis from February 2013 through January 2014; the high-dollar paid claims report and the plan, age, and distribution report for January 2014 and an update for February; and the enrollment activity between February 2013 and January Debbie briefed the Board on an ACHIA-FED enrollee who was waiting to have a triple transplant. She explained that a person who does not have health insurance coverage would not be able to get a transplant. She said that while the member was on ACHIA-FED, he became eligible for Medicare, accepted Medicare, was sent a notice of non-eligibility for ACHIA- FED, and was terminated. She said the member subsequently became aware that he did not have a Med Supp policy and would still have a significant out-of-pocket responsibility for the transplant. The medical provider would not allow the member to stay on the transplant list until he satisfied their concern about how he would pay the out-of-pocket. Debbie said she had Premium Billing and Enrollment contact the member to discuss supplemental coverage on the ACHIA Medicare Carveout plan. She said he might enroll in the ACHIA Medicare Carveout plan in order to satisfy the medical provider's requirements so he can have the transplant. Chet asked what the status of the pre-ex would be in that case if he came onto ACHIA, and discussion was heard. Debbie said she would review the requirements to determine how long a person has to enroll in ACHIA once their previous coverage is terminated, but this person would be eligible because he has had continuous coverage in one plan or another up until the time he would enroll in ACHIA. Debbie recapped the ACHIA-FED enrollments and reasons for terminations from February 2013 through January Financial Reports for ACHIA-FED Bernie reviewed with the Board the ACHIA-FED financial reports for January 31, 2014, starting with the cash flow statement. He reviewed the process for drawing claims for funding and admin expenses and recapped the funding summary. He said there was currently an excess of funding, and they had planned ahead for the decrease in enrollment figures and the high transplant claims that Debbie had just briefed the Board on. He stated that HHS wanted them to stay under the 10% cap, and they were well within the cap. Bernie advised that John Leemhuis was at BMI the first week of February, and BMI had reviewed the draft audit report. He said John expected to complete the audit by the end of February.

4 Tuesday, February 25, 2014 Page 4 of 5 Cecil said he had advised CCIIO that ACHIA-FED had a funding surplus at this time, but he had not heard back from them regarding what would become of the surplus. He said he had discussed with CCIIO that Alaskans have the ability to file claims for up to three years. Katie confirmed that that was the statute of limitations for filing a claim in Alaska. Cecil said that CCIIO had an 18-month runoff period with the expectation that the pool could be closed by the end of September 2015, but there was a discrepancy between the statutory time limit and the contractual time limit. Chet suggested sending a letter to enrollees letting them know that time was of the essence in getting their claims submitted. Cecil said they would revisit this issue at the annual meeting in June. Chet said the Board should keep in mind that there would be expenses related to the transplant that Debbie had reported on earlier. Cecil agreed. 5. ACHIA-FED Current Enrollment Details Cecil - At Risk Financial status - Cecil It was reported that there were 5 individuals paid through the end of January. 6. Marketplace Discussion and Status of ACHIA - All Citing the problems with launching the federal government website, healthcare.gov, and the President's delays, postponements, and extensions of time, Jeff said they had seen less new business in the individual market than they had anticipated. He said between 8,000 and 10,000 people have enrolled in individual plans so far, about a third of the enrollments that were expected to date. He said they would continue to monitor the issue and revisit it at the annual meeting. With respect to the continued operation of ACHIA, Cecil said he had discussed with CCIIO what they would need to do to continue doing business in Alaska into He reminded the Board that they had received a dispensation for 2014, but pending any additional delays, extensions, or postponements by the president, they would need to revise their products to comply with federal specifications going into In response to Jeff, Katie said a legislative change would be needed to bring the ACHIA program into federal compliance going into Jeff noted that the legislative session would end in a few weeks, and discussion was heard. 7. Actuarial Committee None There was no report from the Actuarial Committee, and this item was tabled. 8. Grievance Committee Brian Brian reported that the Grievance Committee met January 27, 2014 to review a grievance. He said an ACHIA policyholder was traveling in Pennsylvania, fell ill, went to the hospital, felt better, was sent home, then went into pain again and went back to the hospital. He said she was admitted on an observation level, so the stay was determined not to be medically necessary. He said the Grievance Committee had reviewed the case and determined that the claim for the hospital stay would be paid. Debbie added that at the Grievance Committee's request, BMI contacted the medical provider twice to request a cost reduction. She said BMI had advised the provider that they should have alerted the member that the coverage had been denied by

5 Tuesday, February 25, 2014 Page 5 of 5 utilization review for those days, but the hospital declined to reduce the bill claim on both occasions. She said that BMI had received authorization from ACHIA, and the claim was paid for the member by ACHIA. 9. PBM Report Alan Alan said they receive the rebates that are provided on a quarterly basis, and they had discovered discrepancies for the second quarter He said the rebates arrive nine months in arrears, so Express Scripts referred to the contract and said there would be an annual true-up six months after the close. He said they stopped the rebate process to wait for the end of the year and closing of the rebates in June 2014 for calendar year Alan said that they were late in receiving the data from Express Scripts because they had a change in personnel, but the data would be available the next day, and it would be reviewed for accuracy. He said a true-up would be done within the next couple of weeks. 10. Vaccine Update None Jeff advised that legislation for the vaccine program was introduced and hearings held, but it was determined that the direction of the legislation would not include ACHIA or BMI as the administrator for the vaccine program. 11. Audit Committee None There was no report from the Audit Committee, and this item was tabled. 12. Advertising Committee None There was no report from the Advertising Committee, and this item was tabled. 13. Annual Meeting Date Confirm June 25-26, 2014 Cecil said the annual meeting was scheduled for Wednesday and Thursday, June 25 and 26, 2014, with dinners on the evenings of June 24, 25, and 26. He said the hotel had advised him that Friday the 27th was booked up, and he urged everyone to make their reservations if they had not already done so. 14. Next Meeting Date Discussion Cecil said the Board would be polled for availability for the next teleconference meeting. 15. Other There was no other business. 16. Adjourn The meeting was adjourned at 11:05 a.m. Alaska time.