California has an exceedingly complex commercial health insurance regulatory and business environment. The state has one of the highest concentrations of managed care in the nation. At the same time, commercial insurers have undergone a rapid process of consolidation. In addition, California is the only state in the nation that has two different state agencies regulating commercial insurers: the Department of Insurance regulates traditional indemnity insurers (typically PPO products) and the Department of Managed Health Care regulates Knox-Keene licensed plans (typically HMO products).
CHA helps members navigate this difficult environment. CHA creates a forum to address emerging issues directly with health plans and insurers. In addition, CHA advocates on behalf of hospitals in the Legislature and courts, as well as before regulatory agencies, to ensure hospitals are paid promptly and fairly. The CHA Managed Care Committee, comprised of a representative sample of members, helps guide the development of policy related to commercial insurance and managed care.
CHA and other hospital organizations testified yesterday at a hearing held by the Department of Insurance to review possible revisions to its network adequacy regulations. The Department plans to revise its regulations to respond to changes in health coverage resulting from the Affordable Care Act and related state legislation. CHA, along with Private Essential Access Community Hospitals and the California Children’s Hospital Association, testified about the impact of network changes on hospitals. CHA focused its comments on the trend toward narrow networks and the impact on rural hospitals, academic medical centers, children’s hospitals and behavioral health providers.
Insurance Commissioner Dave Jones, who chaired the hearing, noted testimony from several participants regarding the need to ensure that the physicians and specialists who refer and practice in network hospitals are also in the network – otherwise the coverage is illusory. CHA also highlighted the importance of provider networks including the full spectrum of post-acute care services. CHA’s comments are attached.
Covered California has released the latest revision to the exchange’s qualified health plan model contract. Covered California will finalize the model contract and release a redline version and a clean version of the model contract on May 3. The Covered California Board of Directors is scheduled to approve the model contract during a special meeting scheduled for May 7 from 9 a.m. to noon. For more information about the May 7 board meeting, including location and agenda, visit www.healthexchange.ca.gov/BoardMeetings/Pages/Default.aspx.
For more information about the model contract and recent changes, see attached:
The state of California has been active creating a brand new marketplace for health care — the California Health Benefit Exchange (CHBE). Health plans have been busy too, filing certification applications, creating products for CHBE and developing networks of providers to support the products. With all this activity, providers and purchasers are asking questions — lots of them. This webinar addresses the latest developments at CHBE and explores your most pressing concerns.