- 1. Connecticut Department of Social Services Prospectus: Health
Care Contracting Opportunities Charter Oak HUSKY A HUSKY B October
2007 M. Jodi Rell, Governor Michael P. Starkowski,
Commissioner
2. Prospectus - Table of Contents
3. My goal is to make sure that every adult and child in
Connecticut has access to health insurance. Governor M. Jodi Rell
(December 27, 2006) 4. Introduction: DSS to Release RFP in November
2007
- Connecticut Department of Social Services (DSS) anticipates
releasing a Request For Proposal (RFP) in November 2007 for
qualified carriers and managed care organizations to provide health
care services to the combined HUSKY and Charter Oak programs
- This prospectus is intended to provide interested parties with
background information about the upcoming opportunity to win a
contract under DSSs competitive procurement to provide health care
services to an estimated 350,000 Connecticut citizens
5. 1. PURPOSE 6. Purpose: Competitively Procure Health Care
Contracts July 1, 2008
- Section 23 of Public Act 07-02 (June Special Session)
authorized DSS to enter into contracts with carriers and managed
care organizations effective July 1, 2008, to provide services for
the newly created state-sponsored health coverage program known as
theCharter Oak Health Plan
-
- Charter Oak, designed to provide premium assistance in the form
of premium subsidies to uninsured adults, with incomes up to 300%
of the federal poverty level (FPL), is one piece of the states
commitment to provide universal access to affordable health
insurance for Connecticut adults of all incomes
- DSSs existing managed care programs,HUSKY A & HUSKY B ,
haveapproximately 320,000 covered lives.DSS will enter into new
contracts with carriers and managed care organizations,effective
July 1, 2008
7. 2. OPPORTUNITY 8. Opportunity: Combined HUSKY/Charter Oak
Procurement
- A combined procurement for HUSKY and Charter Oak will cover an
estimated 350,000 Connecticut citizens for a period of at least 3
years and up to 5 years, with a total contract value projected to
be in excess of $3.5 billion over the five-year contract
- Successful bidders will be required to meet the network,
operational, contractual, and financial standards as laid out in
the RFP and provide services for both HUSKY programs, as well as
the Charter Oak program
- All 350,000 lives will potentially be available under this new
contract.New contractors will have the opportunity to enroll
individuals and families through an initial open enrollment period
and receive newly eligible individuals and families
9. 3.HUSKY A HUSKY B/HUSKY PLUS 10. DSS Health Care Programs:
HUSKY Plan
- HUSKY A Comprehensive health care coverage servinglow-income
children, parents, relative caregivers with incomes up to 185% of
FPL
-
- Includes pregnant women with incomes up to 250% of FPL
-
- Traditional Medicaid health coverage
- HUSKY B Health coverage for uninsured children in moderate and
higher income families, 185% - 300% of FPL (unsubsidized group rate
coverage over 300% of FPL)
- HUSKY Plus A supplemental program for children with special
medical needs available to participants enrolled in HUSKY B (185%
-300% of FPL). HUSKY Plus benefits are paid on a feefor-service
basis through DSS contracts
11. 4. CHARTER OAK HEALTH PLAN 12. DSS Health Care Programs:
Charter Oak Health Plan
- Charter Oak is designed to provide an affordable health
insurance product to adults of all incomes at a target total
premium of $250 per member per month
- Charter Oak is not Medicaid: benefits will be based on a
commercial model, with enforceable deductibles, co-pays, and
coinsurance
- For individuals with incomes less than 300% ofFPL, premium will
be subsidized by the state according to a fixed sliding scale
13. Charter Oak: FPL Table and Projected Enrollment Total Cost
of Monthly Premium 32,800SFY11 Average 21,400SFY10 Average
8,700SFY09 Average Clients Total 14. 5. PROCUREMENT 15.
Procurement: Combined to Balance Risk and Simplify
Administration
- DSS will release a Request for Proposals for thecombinedHUSKY
A, HUSKY B and Charter Oak programs in November 2007
- DSS is combining the procurement to allow the successful
bidders to balance the familiar risk and large size of the HUSKY
enrollment with the less familiar and less predictable size of the
Charter Oak enrollment
- DSS has a long, proven track record, having administered
Medicaid Managed Care since 1995, and the HUSKY Plan (A/B) since
1998. Using this established infrastructure will allow for
simplified administration of the combined procurement and reduce
the risk to successful bidders by utilizing an existing, known
implementation process
16. 6. TIMELINE 17. Timeline: HUSKY/Charter Oak Procurement
- Release of Prospectus October 2007
- Release of RFP November 2007
- RFP Bidders Conference December 2007
- RFP Bids Due January 2008
- RFP Negotiations February 2008
- Contract Effective Date July 2008
18. 7. PROCESS 19. Process: Soliciting Feedback and
Partnering
- DSS is soliciting feedback and interest from qualified carriers
and managed care organizations up to the release of the RFP in
November 2007.Where appropriate, DSS will incorporate the feedback
into the RFP
- DSS will make the data available electronically used in the
HUSKY rate setting process to help interested parties more fully
understand the risk of the HUSKY program and assist in projecting
risk of the Charter Oak program
- DSS will conduct a Bidders Conference and will provide a
question and answer process to allow interested parties to interact
with the States health policymakers and more fully understand the
HUSKY and Charter Oak programs
20. Process: Soliciting Feedback
- Simultaneous with this prospectus, the Department is finalizing
the RFP for the combined HUSKY and Charter Oak procurement.Per the
attached timeline, DSS expects to release the RFP within the next
30 days.To solicit comments on the procurement prior to the RFP
release, DSS has established the[email_address]mailbox
- Interested parties should e-mail their comments to this
mailbox.All comments will reviewed by the Agency.Any comments
requiring responses will be sent to all interested parties that
register by submitting an e-mail labeled Request for Registration
to the above mailbox
21. 8. RATE SETTING 22. Rate Setting Methodology:HUSKY A &
HUSKY B
- Rates required to be Actuarially Sound per CMS
Requirements
- Rates set for State Fiscal Year (SFY).Rates Effective July 1,
2008 will be in effect for SFY09 (July 1, 2008, to July 1,
2009)
- Rates are based on Health Plan Financials and Encounter data,
adjusted for:
23. Rate Setting Methodology Changes: Under ConsiderationHUSKY A
& HUSKY B
-
- Maternity and newborn kick payments
- Future Rate Years - Changes Under Consideration
-
- Pay-for-Performance Incentives
-
- Minimum Loss-Ratio Standards
-
- Quality/Evidence-Based Payment Incentives
24. Rate Setting Methodology: Charter Oak
- Rates will be Actuarially Sound and able to meet CMS
Requirements
- Rates will be set for State Fiscal Year (SFY).Rates Effective
July 1, 2008 will be in effect for SFY09 (July 1, 2008 to July 1,
2009)
- Rates will be based on HUSKY A adults data, adjusted for
differences in:
25. Rate Setting Methodology: Charter Oak
- Incentives/Sanctions DSS is considering placing funds at-risk
for contractor performance standards in several areas,
including:
-
- Geographic distribution of key provider types for overall
network access requirements
-
- Availability of scheduled appointments for primary care and
specialty physicians for meeting appointment scheduling waiting
standards
-
- Telephonic wait times, call abandonment and resolution rates
for member and provider customer service standards
-
- Claims adjudication times for meeting claims payment timeliness
requirements
26. HUSKY AActuarially-soundFiscal Year 2005 2007Capitation
Rates*FY05 and the First Half of FY06 include capitation amounts
for specialty behavioral services ** Second Half of FY06 and FY07
exclude capitation amounts for specialty behavioral services $
188.59$ 179.90$ 199.03$ 188.80Total $ 263.66$ 252.39$ 271.60$
257.4740+ F $ 276.01$ 264.28$ 283.57$ 268.5040+ M $ 249.45$ 238.59$
257.72$ 244.4915-39 F $ 142.80$ 135.94$ 155.12$ 147.0715-39 M $
110.16$ 104.28$ 123.40$ 117.071-14 $ 677.37$ 650.45$ 669.59$
635.40