BOSTON – The Mass. Health Insurance Connector Authority Board has approved guidelines for contracts with managed care companies involved in the Commonwealth Care program that include incentives for cutting costs and provisions to protect patients.
Commonwealth Care health plans cover 162,000 residents whose incomes are too high to qualify for the state Medicaid program, MassHealth. The new guidelines are for contracts that will be sent out to bid in January and take effect on July 1.
The new provisions limit insurers to a 2-percent increase over what was paid to carriers this fiscal year, compared with 8 to 9 percent allowed in the private sector. The lowest bidders will be able to automatically enroll fully subsidized Commonwealth Care beneficiaries who drop coverage, wait more than three months to re-enroll and then don’t pick a new plan.
To protect patients, the guidelines forbid switching beneficiaries to a less-costly plan if it doesn’t include the person’s regular physician. Beneficiaries with serious, chronic illnesses also would be protected from automatic enrollment.
The guidelines also include incentive payments of $2 per patient per month for plans that improve the share of patients getting comprehensive annual physicals by at least 5 percentage points. A $1 per patient monthly incentive will be paid to insurers who report every quarter how their members are using emergency departments.
Separately, Gov. Deval L. Patrick recently released a survey report showing that more than 97 percent of Massachusetts residents now have health insurance, and only 2.6 percent, or about 167,000 people, had no coverage as of this summer.
“Massachusetts has succeeded in covering the uninsured at an amazing rate,” said Mass. Secretary of Health and Human Services Dr. JudyAnn Bigby.
“Massachusetts now has both the lowest rate of uninsurance in the country and a rate that is less than half that of the next lowest state. The results also show that we have covered nearly every child in the Commonwealth. This is a remarkable achievement, and Massachusetts has already begun to see the benefits.”
The survey was conducted by the Mass. Executive Office of Health and Human Services’ Division of Health Care Finance & Policy. Additional information – including the full report, “Health Insurance Coverage in Massachusetts: Estimates from the 2008 Massachusetts Health Insurance Survey” – is available online at www.mass.gov/dhcfp.
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