Connecticut Department of Social Services

1. ConnecticutDepartment of Social Services Health Care Contracting Opportunities Charter Oak – HUSKY A – HUSKY B Bidders’ Conference February 22, 2008 M. Jodi Rell, Governor Michael P. Starkowski, Commissioner

2. AGENDA • Introduction • Process • Questions • HUSKY • Charter Oak

3. HUSKYCost Proposal Requirements • Submit eight hardcopies and two electronic copies • Includes CRCS forms for each rating category (7 for HUSKY A, 3 for HUSKY B plus Charter Oak) • Supplemental newborn and maternity information for HUSKY • Supporting narrative detailing assumptions for bid preparation – separate for HUSKY and Charter Oak • Schedule 1: Certification statement – applies to both HUSKY and Charter Oak • Schedule 2: HUSKY and Charter Oak administrative cost detail • Schedule 3: HUSKY and Charter Oak supplemental information on capitated risk arrangements

4. HUSKY CRCS Sheet

5. HUSKYProgram Changes • DSS has implemented a number of recent program changes that bidders will need to consider • Change in eligibility for pregnant women • Increase in the Medicaid fee schedule for hospitals, clinics, physicians and vision • Implementation of Medicaid floor • Carve out of pharmacy and dental services

6. HUSKY Rate Negotiation Process • Final HUSKY rates are required to be actuarially sound per CMS regulations • Mercer to determine actuarially sound rate ranges prior to bid submissions • Rates submitted outside of the actuarially sound rate range will receive counter “offer rate” from DSS • If necessary, negotiations will be conducted to ensure final rates are within the actuarially sound rate range.

7. Bidders’ Library • HUSKY A historical eligibility and encounter data available upon request • Only HUSKY A encounter data available. No encounter data available for HUSKY B • Due to data limitations, encounter data service categories more limited than those requested in CRCS • Bidders encouraged to use own information to supplement data in bidders’ library

8. Charter Oak Cost Proposal Requirements Process • Submit eight hardcopies and two electronic copies • Includes CRCS forms for Base RFP Plan Design and, if necessary, alternative Plan Design rating category • Supporting narrative detailing assumptions for bid preparation – separate for HUSKY and Charter Oak

9. Charter Oak Cost Proposal Requirements Highlights • Two-Tier Rate Structure • Community Rated with Individual Target Premium of $250, regardless of age, sex, or geography for individuals with Incomes Above 300% FPL • Ability to Adjust Rates for Individuals with Incomes Below 300% FPL by FPL Band • MCOs not at risk for BH and Rx, but those services included within $250 Target Premium • Note: BH subject to limitations

10. Charter OakFPL Table and Projected Enrollment Total Cost of Monthly Premium

11. Charter OakProgram Design • Geographic Area • Statewide Status: Anticipated Carriers will offer Coverage Statewide • Program Structure • State Program*: July 1, 2008 • Authority • Section 23 of Public Act 07-02 (June Special Session) • Type of Enrollment • Voluntary, Affordable Health Insurance • Individuals without health insurance for the last six months or those who meet certain qualifying criteria to exempt them from uninsurance requirement • Excluded Populations • Individuals currently insured or insured within last six months (exemptions to be determined) • Individuals eligible but not enrolled in Public Programs (SAGA, HUSKY A and B, etc) * DSS anticipates submitting a waiver to the Connecticut Legislature, and if approved, to CMS for Federal financial participation in portions of Charter Oak

12. Deductible Varies by FPL Co-insurance Varies by service Out of Pocket Maximum Varies by FPL Lifetime Benefit Maximum $1,000,000 Premiums by enrollee *Maximum $250/month Varies based on income Primary Care Physician Visits $25 co-pay Specialist Physician Visits $35 co-pay Preventive Care No co-pay, 100% covered Inpatient Hospital 10% Co-insurance Outpatient Surgical Facility 20% Co-insurance Ambulance/Transportation 100% Covered in emergencies Rx - $7,500 Annual Limit DME - $4,000 Annual Limit Behavioral Health Services, Rx services carved-out and provided through DSS Dental and Vision Services may be provided as optional riders by MCOs with separate premium assessment Charter OakBasic Benefit Features See Appendix C in RFP: Charter Oak Plan Design Summary Table for additional detail * Includes aggregate cost for medical, behavioral health and Rx carve-out

13. Charter Oak CRCS Sheet (Top)

14. Charter Oak CRCS Sheet (Bottom)

15. Charter OakRate Negotiation Process • Final Charter Oak rates are required to be actuarially sound per CMS regulations* • srHS to determine actuarially sound rate ranges prior to bid submissions • Rates submitted outside of the actuarially sound rate range will receive counter “offer rate” from DSS • If necessary, negotiations will be conducted to ensure final rates are within the actuarially sound rate range * DSS anticipates submitting a waiver to the Connecticut Legislature, and if approved, to CMS for Federal financial participation in portions of Charter Oak