Moda leaves WA | Amina Suchoski | New network adequacy rules

The risk corridor announcement that payments will be only a fraction of what was intended in the 2010 bill has plans shuttering operations all over. Moda announced it will leave Washington, but three plans left Alaska in 2015 and 10 of the 23 co-ops have closed nationwide, including one in Oregon.

Based on what we hear, this isn’t the last major plan announcement in Washington State before the end of the year. So, get your popcorn.

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1. Moda withdraws from Washington

Moda Health, with 47,000 members in the state, announced that it will be leaving the Washington market. All sales and renewals will cease effective immediately. Under rules of guaranteed renewability of coverage, this means the plan cannot reenter the state for 5 years. Moda had won approval to enter the SHOP marketplace to serve small businesses, one of the lagging areas of Exchange activity. This leaves UnitedHealthcare as the only plan offering statewide SHOP plans going into Open Enrollment next week. the 5% of QHPs sold on the Exchange in 2015 to Moda will also be divided among the remaining 12 issuers.

We have comments from the Pam MacEwan, CEO at the HBE, as well as from the OIC. Moda’s primary Washington State partner, Associated Industries, has also given us a statement. Moda’s original statement is here.

2. A more competitive Exchange market

In three days, Open Enrollment begins. This year, health plans will find themselves in a much more competitive market with 116 new individual market plans approved by the Exchange and two newcomers, national giant United HealthCare and Health Alliance Northwest – though we haven’t backed out the Moda plans yet.

United HealthCare will be offering 32 new QHPs–making up about 29% of the Exchange’s Gold offerings and a quarter of the Exchange’s Silver offerings. It appears that Molina will have both the lowest and second lowest-priced Silver plan offered in King County, coming in around $220. With price the primary variable in consumers’ decision making, Molina stands to gain significant market share.


3. Feds pass hospital site neutral payments

The House passed its proposed two-year budget today which targets $7.5 billion in savings over five years from a single provision (SEC 603) that mandates all new hospital outpatient department (HOPD) services only receive Medicare payments equal to the physician fee schedule. The provision was vocally opposed by the Washington State Hospital Association (WSHA) for its potential impact to hospitals still integrating physician practices into their outpatient departments.

But lobbyists are saying that this payment reform is the lesser of evils. Arguing against American Hospital Association claims that the move will hinder patient access to services, supporters of the provision claim that getting rid of “unfair payment disparities for identical clinical services” will put the kibosh on “market consolidations that limit patient access.”

4. Video: Amina Suchoski, United HealthCare

We caught up with Amina Suchoski, Vice President of Marketing and Business Development at United HealthCare Community Health Plan of Washington, at our recent Inland Northwest conference. Undoubtedly, one of the hottest issues that day was the behavioral health integration pilot program in Southwest Washington.

Suchoski is excited about the empowerment that she is seeing the state give Washington’s ACOs. She shares United Healthcare’s vision for setting up sustainable infrastructure and forging key relationships the region during this phase. Watch her talk about state innovation here.


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5. New rules in network adequacy

The National Association of Insurance Commissioners (NAIC) is set to adopt a model law in November which makes clearer provisions for accurate provider directories, surprise billing, and rule-making authority in the states. The draft bill is the first update in nearly a decade and will serve as a model for all states to use during their 2016 legislative sessions. It will also guide HHS standards for 2017 plans.

Sources tell us that the OIC will be requesting legislative authority to deal with the surprise billing issue during this coming legislative session. Network access rule making hasn’t moved much with the agency since the July hearing. So, it will be interesting to see how the OIC adopts new standards put forth in this model act.