Report 2013-602 Recommendation 2 Responses

Report 2013-602: New High Risk Entity: Covered California Appears Ready to Operate California's First Statewide Health Insurance Exchange, but Critical Work and Some Concerns Remain (Release Date: July 2013)

Recommendation #2 To: Covered California

To comply with federal requirements, Covered California should develop a plan and procedures for monitoring, recertification, and decertification of qualified health plans.

Annual Follow-Up Agency Response From February 2016

See Auditor's Assessment below.

California State Auditor's Assessment of Annual Follow-Up Status: Fully Implemented

We reviewed Covered California's implementation of this recommendation as part of our February 2016 report titled High Risk-Covered California: It Must Ensure Its Financial Sustainability Moving Forward, and Its Use of Sole-Source Contracts Needs Improvement, Report 2015-605. Based on our review, we assessed Covered California's implementation of this recommendation as fully implemented.

Annual Follow-Up Agency Response From October 2014

Covered California will be continuing its efforts as stated in the 1-year response submitted July 11, 2014 and provide additional supporting documents as they become available.

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented

1-Year Agency Response

The Plan Management Division and the Qualified Health Plan team recognizes and understands that a robust portfolio of health and dental insurance issuers on the California Health Benefit Exchange is beneficial to California consumers. The California Health Benefit Exchange completed a comprehensive Solicitation process in 2013, and is utilizing the experience from that Solicitation in the design and implementation of the monitoring, certification and recertification processes going forward. As we have stated, this process will not be completed until the regulators have approved final rates in the late summer 2014 timeframe (at which point certification become official). However, we continue to adjust and perfect the plan, which remains on schedule.

As mentioned in our last update, while subject to potential modification due to unforeseen events, the Qualified Health Plan team has defined hard dates starting in January 2014 through 2015. These dates include Board approvals for accepting recertification criteria, renewal and new entrant application deadlines, issuer submission dates for rates and network updates, negotiation periods and regulatory approvals.

Covered California has included, and continues to apply, input from Qualified Health Plans and other stakeholders in the final design component of our renewal and new entrant processes. We continue to work collaboratively with our Qualified Health Plans and stakeholder groups to keep them informed on the progress of our process development.

California State Auditor's Assessment of 1-Year Status: Pending

6-Month Agency Response

The Qualified Health Plan team recognizes the importance of both building and maintaining a robust portfolio of health and dental insurance issuers on the California Health Benefit Exchange. Following our comprehensive Solicitation process completed in 2013, the team designed and is currently implementing the monitoring, certification and recertification processes required by law. While this process will not be completed until the regulators have approved final rates in the late summer 2014 timeframe (at which point certification become official), milestones in the plan have been accomplished.

Timetable Established

While subject to potential modification due to unforeseen events, the Qualified Health Plan team has defined hard dates starting in January 2014 through 2015. These dates include Board approvals for accepting recertification criteria, renewal and new entrant application deadlines, issuer submission dates for rates and network updates, negotiation periods and regulatory approvals.

Covered California has included input from Qualified Health Plans and other stakeholders in the design of our renewal and new entrant processes. Additionally, we have shared publically our timelines to ensure our Qualified Health Plans and stakeholder groups are informed about the process.

California State Auditor's Assessment of 6-Month Status: Pending

60-Day Agency Response

The QHP team recognizes the importance of both building and maintaining a robust portfolio of health and dental insurance issuers on the California Health Benefit Exchange. Following our comprehensive Solicitation process completed in 2013, the team started building the monitoring, certification and recertification processes required by law. While this process has not been completed, certain milestones in the plan have been accomplished.

Timetable Established

While subject to potential modification due to unforeseen events, the QHP team has defined hard dates starting in January 2014 through 2015. These dates would include Board approvals for accepting recertification criteria, issuer submission dates for rates and network updates, negotiation periods and regulatory approvals.

Preliminary Process Established

The QHP team has defined a summary process that outlines the end-to-end process for recertification. The process would include initial plan performance analysis, setting recertification criteria, plan evaluation against these criteria, Board approval of recertification recommendations, and regulatory approvals.

By the end of October 2013, the QHP team anticipates that the process will be more comprehensively documented, reviewed and approved by the Board and then shared with the portfolio of plans currently on the exchange. Included in this process will be a consideration to include new plans via a scaled back initial solicitation process.

California State Auditor's Assessment of 60-Day Status: Pending

All Recommendations in 2013-602

Agency responses received are posted verbatim.