Premera, Regence, CHPW support reimbursement mechanism in public option bill

Premera Blue Cross, Regence Blue Shield and Community Health Plan of Washington have told Senators they now support the reimbursement mechanism included in the public option legislation, SB 5526.  This follows changes made to the bill in the House, which moved the bill off the floor last Wednesday.

In a letter sent to the legislature last week, the carriers said

“This legislation will ensure that patients in Washington’s individual market will have less expensive premiums and more affordable deductibles. This is achieved by creating standardized plans and by addressing the underlying cause of high health care costs through a flexible provider reimbursement structure.”

You can read the full letter here.


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Last week, Rep. Eileen Cody suggested this support was in place ahead of votes.

“The carriers believe that this should lower the price about, between 5 and 10% and it will not affect the large group and small group markets, so hopefully we have found the sweet spot.”

The amended version includes reimbursement rates pegged at no greater than 150% of Medicare, which will likely impact facilities more than professional reimbursement. Primary care rates have a floor of no less than 135% of Medicare.

The amendments also have a number of limits on which kinds of plans can participate.  A public option health plan will also have to offer at least one bronze, silver and gold QHP. So, Medicaid or Medicare plans that are not already active on the exchange will face significant administrative hurdles to participate in Cascade Care.

Likewise, any plan that is not already on the exchange in some way, will have further complications as the amended version will not allow the HCA to contract with any plan for Cascade Care until they have cleared all QHP certification hurdles.

That QHP process typically concludes in September ahead of open enrollment to begin just a few weeks later.  So, plans will need to be sure they have adequate networks and operations in place to be able meet requirements from the HCA well before a contract is signed for the work. Building a new provider network under these circumstances will be extraordinarily difficult.