Heathcare policy & Benefit services division header

December 2, 2013

Meeting Called to Order by Thomas Woodruff

New Business:

Financials and Dashboard - Dave Williams presented the monthly dashboard report on financials. It was noted that claims experience is running well with combined medical and pharmacy trends running in the single digits. Population increases should be noted as well as a peak compliance period for the HEP, which could potentially increase claims.

Partnership Update - Staff reported that membership remains steady with only one group joining for 12/1/13. Staff will be marketing the Partnership plan early next year. A discussion of the pharmacy only coverage was tabled until next month.

HEP Nurse Visits to 55 Elm Street - Staff announced that the HEP nurses met with 18 members on their 11/20/13 visit to 55 Elm Street for chronic condition counseling. There were also 2 Health Navigators in the lobby to answer questions and hand out chronic condition education materials from 8 AM to 1 PM. The visit was well received and OSC and CMS plan to schedule additional agency onsite visits in 2014.

SIM Update - Tom provided an update on the work being done on the SIM project. The state?s final proposal is anticipated for submittal to CMS by the end of the year.

Dental RFP - Milliman will be scheduling a meeting this week for the committee to review the draft and set the timeline so the RFP can be issued.

Transgender benefits - The parties agreed that Public Act 11-55 requires covering transgender benefits to the extent medically necessary. Therefore we agree that transgender-related medical procedures are included in the plan to the extent medically necessary.

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