Broad View: October 2013

Michael_RBy: Michael Ranney, MPA, OPA Executive Director

The Health Care Provider Coalition had a productive and informative meeting with Carrie Haughawout, Assistant Director for Health Policy at the Ohio Department of Insurance (DOI) on September 16.

Even though Ohio opted for a Federal Exchange, the state will continue to determine Medicaid eligibility and regulate insurance in Ohio. DOI anticipates that between 500,000 and 750,000 people will enroll in the exchange in year one. Estimates from other sources vary, with many expecting a lower number. Still, there are significant, and we believe valid, concerns about the adequacy of the health care workforce.

She helped put things in perspective. The Affordable Care Act (ACA) set a July 31 deadline for state insurance departments to review all plans that would be in the health exchange market. Typically, after the department approves a plan it only reviews amendments to the plan. This is a new day with new plans, requiring review of all plans, which put the DOI under great pressure. There is an October 1 deadline to review all plans that are in the off exchange market. All this extra work explains why it has been difficult to get much information from the department.

There are mixed opinions about whether or not the exchange will be ready to open by the deadline. It is a source of much drama.

DOI has posted some FAQ’s on their website. These are primarily consumer oriented and if your patients are asking for information this would be a good place to send them.

Through the Provider Coalition we will be in regular and frequent contact with DOI to discuss provider issues, so if you have questions you want us to raise please pass them along me.

There is evidence that some carriers are scaling down their networks. We have heard this from some of our members. The ACA does include new network adequacy requirements, which we will be monitoring. Twelve carriers have been certified to move onto the exchange and they will be listed on the DOI website (probably by the time you see this).

We discussed the possibility that some of your patients may ask you about the exchange. Here is a good resource for information. (This may be helpful to you as you shop for your own coverage as well!)

Please be careful about recommending to patients that they sign up for a particular plan, particularly if is a plan with whom you are contracted. It is okay to tell patients which plan(s) you accept. To avoid problems you should always recommend that they talk to their insurance agent to find out which plan is best for them. Be careful about this!

DOI is already getting contract complaints from providers. Providers do have the right to ‘opt out’ of contracts/amendments. Please pay careful attention to the amendments you are being offered.

DOI emphasized that provider complaints should go through the Market Conduct Division. If you are making a complaint it would be helpful to let us know too. (Email either Bobbie Celeste or myself  to notify us of your complaint when you file it.) I can’t count the number of times DOI has told us they aren’t getting complaints from psychologists and it helps if we know what complaints have been filed.

Under the ACA, people who are eligible for an insurance subsidy will have 90 days to pay their share. This creates a potential problem if they ultimately don’t pay but receive treatment during that 90 day time period. Providers do have some discretion to require proof of coverage under the ACA. The carrier is responsible for costs accrued during the first 30 days but the provider is responsible for any costs that accrue between 31 and 90 days if the patient does not pay for their coverage.

We are working all our sources to get the latest information. Bobbie Celeste, Heather Gilbert and I are working on OPA’s bi-weekly insurance update to keep you informed and we hope this is helping. Are you finding it helpful? We are repeating some items that have already been posted to be sure you don’t miss important information. This is a critical time and things are changing daily. Please share resources you have found helpful. Send us the questions and concerns you have and we’ll seek out the answers.

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