| Bay State health insurers are largely supportive of the new Baker administration proposal to assess employers and reform MassHealth to cover rising Medicaid costs, but threw up the caution flag recently on one proposal to encourage greater participation in tiered-network plans.
As part of a $315 million revenue and savings package presented to the Legislature for possible inclusion in the fiscal 2018 budget, the governor has asked that the difference in premiums between full and tiered network products be increased from 14 percent to 28 percent. Tiered networks are insurance plans that encourage subscribers to choose lower cost health care providers by offering lower out-of-pocket costs to the patient.
“That’s going to be very difficult for us to achieve. It’s been very difficult for us to achieve the 14 percent,” Massachusetts Association of Health Plans President Lora Pellegrini said in a statement.
Pellegrini said she’d like to work with the administration and the conference committee on that piece to give the health plans additional tools to ensure that providers will participate in tiered-network products without making them a financial liability for the insurers. One of those tools was added to the Senate budget by Sen. James Welch dealing with rates paid to providers who provide out-of-network care and bill health plans.
“We’re supportive of the intent of what they’re trying to do here to make products more affordable, particularly for small business, but we need additional tools to rein in provider costs,” she said in a statement.
Overall, Pellegrini said MAHP was “supportive of what the administration has been trying to do,” and happy to see an agreement reached with key employer groups. Though the administration isn’t counting on any budget savings from the tiered-network changes, Pellegrini said she wanted to be careful not to disrupt the balance of the package that won support from business groups and some providers.
Baker’s plan was submitted to the fiscal 2018 budget conference committee Tuesday afternoon in hopes that it could be folded into the budget, and Secretary of Health and Human Services Marylou Sudders and Administration and Finance Secretary Kristen Lepore said it’s important that the reforms be treated as a package and not considered piecemeal.
