Joint Labor-Management Benefits Committee (JLMBC) COMMITTEE REPORT 18-27

Transcription

1 Joint Labor-Management Benefits Committee (JLMBC) COMMITTEE REPORT JOINT LABOR-MANAGEMENT BENEFITS COMMITTEE MEMBERS: Management Date: May 3, 2018 To: From: Subject: Joint Labor-Management Benefits Committee Staff Projects & Activities Report Wendy G. Macy, Chairperson June Gibson Rich Llewellyn Tony Royster Matthew Rudnick Employee Organizations Cheryl Parisi, Vice-Chairperson Paul Bechely Chris Hannan David Sanders William Violante RECOMMENDATION That the JLMBC receive and file projects and activities report regarding informational items, projects updates, staffing summary, and completed projects/meeting calendar for March- April, DISCUSSION A. Informational Items Anthem Blue Cross (Anthem) Network Agreement Updates Staff provides monthly updates in the monthly projects & activities report regarding Anthem provider negotiations that may potentially impact City members. Below is the monthly Anthem network update for March 16 - April 30, Prime Healthcare Services As reported to the JLMBC at its March 22 meeting, Anthem notified the City on February 26, 2018 that it will not be renewing a joint commercial hospital agreement with the following Prime Healthcare Services hospitals: Centinela Hospital Medical Center Garden Grove Hospital & Medical Center Huntington Beach Hospital La Palma Intercommunity Hospital Paradise Valley Hospital Sherman Oaks Hospital West Anaheim Medical Center The termination of the agreement took effect on March 25, 2018 and applied only to non-emergency hospital services. On March 26, 2018, Anthem notified the City that Prime Healthcare Services has rescinded its termination for these 7 hospitals and the current agreements with these hospitals remains in effect through Universal Health Systems As reported to the JLMBC at its March 22 meeting, Anthem notified the City on March 5, 2018 that it was in negotiations with Universal JOINT LABOR-MANAGEMENT BENEFITS COMMITTEE

2 Health Systems (UHS) to renew their agreement, which was scheduled to terminate on March 30, The UHS agreement covers the following five hospital locations in Riverside and Los Angeles Counties: Corona Regional Medical Center (Riverside, CA) Palmdale Regional Medical Center (Los Angeles, CA) Southwest Healthcare System Murrieta (also known as Rancho Springs Medical Center) (Riverside, CA) Southwest Healthcare System Wildomar (also known as Inland Valley Medical Center) (Riverside, CA) Temecula Valley Hospital (Riverside, CA) The City has had 23 HMO and 7 PPO employees and dependents utilize one of these locations in the past 12 months. The agreement between UHS and Anthem terminated effective March 30, 2018 and notification letters were sent to these employees on April 2, A copy of the notification letter is attached as Attachment B. 3. California Department of Managed Health Care As reported to the JLMBC at its February 8, 2018 meeting, termination of the Employee Health System Medical Group/EHS and Multicultural Primary Care Medical Group, collectively ( EHS ) was effective January 31, 2018 and was a direct result of a recent regulatory directive issued by the California Department of Managed Health Care (DMHC) to all health plans that contracted with EHS, citing concerns with the medical group s referral processes. At its March 22, 2018 meeting, the JLMBC asked for clarification to confirm the number of members impacted by the DMHC directive. Anthem informed the City that a total of 48 members were impacted. 15 of these members were assigned to their same PCP through an affiliation with a different medical group; 33 of these members were assigned to new providers because their PCP had no other medical group affiliation. B. Projects Updates Anthem Preferred Provider Organization (PPO) Member Survey At its February 8, 2018 meeting, the JLMBC approved a survey of LAwell Civilian Benefits Program PPO members. Following this meeting, staff worked with Segal Consulting (Segal) to establish the survey online and a direct mail invitation was sent to all current and former members of the PPO Plan to take the survey. The survey window opened on February 23 and closed on March 23. Staff drafted an for the General Managers of those departments who have a large number of employees enrolled in the PPO Plan to send to its employees to remind them to take the online survey. Staff also reached out to its labor partners to send a similar reminder . As of March 26, a total of 267 survey responses were received, representing approximately 10% of the PPO member population. Staff is now working with Segal to develop and conduct focus groups to obtain additional feedback regarding the components of the survey. Focus groups are scheduled for early May at various locations and different times to 2

3 maximize participation. Staff is currently working with Segal to analyze the survey results and focus group feedback and will report back to the JLMBC with its findings LAwell Benefits Communications Survey At its March 22, 2018 meeting, the JLMBC approved a benefits communication survey of all current LAwell members. The survey window opened on April 9 and closed on April 18. As of the close of the survey, a total of 1,289 survey responses had been received, representing approximately 5% of the active LAwell population. Staff is now working with Segal to develop and conduct focus groups to obtain additional feedback. Focus groups are scheduled for early May at a schedule to coincide but not overlap with the PPO survey focus groups. Staff is currently working with Segal to analyze the survey results and focus group feedback in development of a draft Strategic Plan that will be presented to the JLMBC Ad Hoc Communications Subcommittee Wellness Survey At its March 22, 2018 meeting, the JLMBC approved the 2018 Wellness Survey. The survey window opened on April 23 rd and has been extended to close on May 6, As of April 30 th, a total of 2,009 responses have been received, representing approximately 8% of the active LAwell population Monthly Lunch Time Seminars As reported to the JLMBC at its January 4, 2018 meeting, staff has been working with LAwell benefit service providers and health plan member advocates to develop an on-going lunchtime seminar series for members. The goal of this series is to both educate members and engage them with the LAwell Civilian Benefits Program member advocate and other personalized resources. Staff has established a calendar for these lunch time seminars which will be held on the fourth Thursday of each month. The first lunch time seminar, Understanding Your Vision Benefits, was held on March 22 and was attended by 24 participants. The second lunch time seminar, Finding a Medical Provider, was held on April 26 and was attended by 10 participants. The remaining schedule of lunch time seminars, provided below, is tentative and subject to change: - May 24 Pharmacy June 28 Coordination of Benefits - July 26 Preventative Care - August 23 Medicare & LAwell - September 27 Tax-Advantaged Spending Accounts 101 Benefits Service Provider Summit Staff has been working with Keenan & Associates (Keenan) to develop a structure and schedule for ongoing Benefits Service Provider summits. As reported to the JLMBC at its February 8, 2018 meeting, the goal of the summits is to create a group structure for what have in the past been individual carrier meetings; and further develop a goals and outcomes approach to evolving services, fully utilizing benefit service provider resources, and improving member outcomes. Targeted areas include but are not limited to Wellness and include preventive services, benefit and program utilization (including condition management), communications, and data management. The first Benefits Service Provider summit was held on March 30, Staff is currently working with Keenan & Associates to schedule a second summit at the end of June. 3

4 Electronic Eligibility File and Telephonic Claims Intake Process for Disability Claims Since October 2017, staff has been working with the LAwell Civilian Benefits Program s life/disability/accidental death & dismemberment insurance provider, The Standard Insurance Company (Standard) and the City s benefits Third-Party Administrator, Mercer to implement an electronic eligibility file that would allow the City to move to a telephonic claims intake (TCI) process to streamline the disability claims submission process for the employee and the City. The TCI process will allow employees to submit claims to Standard via phone with a Claims Intake Representative (currently, this is done through filing a paper application) and employer information such as the type of plan the employee is enrolled in (e.g. basic or buy-up plan) will be provided on the electronic eligibility file (currently, this is being performed manually by Employee Benefits Division staff). Information that cannot be obtained on the electronic eligibility file will be requested via on the same day as the intake call thereby reducing the amount of time required to file a claim. Weekly meetings were held with Standard and Mercer to review and approve data file layout specifications, test file exchanges, and review test results to ensure all issues were resolved prior to implementing a full production file. The first full production file was successfully received by Standard on March 14 and staff will monitor the progress of the next few eligibility files to ensure there is a seamless transmission of data. In the meantime, staff is working with Standard to schedule and conduct trainings for human resources staff in City departments to inform and educate them of the new TCI process so that they can then provide proper education and instruction to their employees regarding the disability claims application process. Kaiser Permanente Copay for Pediatric Non-Preventive Visits At its May 23, 2017 meeting, the JLMBC was informed of copayment changes made to Anthem and Kaiser non-preventative pediatric visits in compliance with Affordable Care Act nondiscrimination provisions. As a result, medical services that can equally apply to both adults and children must have the same copayment applied for the same service. For pediatric care visits that do not have an adult equivalency, no change was made. Since this change went into effect in January 2018, staff has received several inquiries from Kaiser members and has developed a brief communication piece, as shown in Attachment C, to help answer member questions. This communication piece has been added to the website and its Frequently Asked Questions section. C. Staffing Summary Elvira Mendez has accepted the position of Benefits Specialist effective March 19, Ms. Mendez previously worked in the Employee Benefits Division as a Member Services Representative providing direct support and customer service to the members of the LAwell Civilian Benefits Program. Following is a summary of staff positions supporting the LAwell Civilian Benefits Program: Personnel Position Authority Staff Member Function Est. % Allocated to LAwell Program Chief Personnel Analyst Steven Montagna Division Chief 60% Senior Personnel Analyst II Jenny Yau Section Manager 100% 4

5 Senior Personnel Analyst I Daisy Tam TPA/Payroll/Kaiser 100% Senior Personnel Analyst I Paul Makowski Communications/Audits/Budget 100% Senior Personnel Analyst I Leo Reyes Wellness Program Coordinator 100% Personnel Analyst Russell Escueta Administration/COBRA/Anthem 100% Personnel Analyst Helen Georgeson Participant Services/JLMBC 100% Personnel Analyst Theodore Vasquez Wellness Program Assistant 100% Benefits Specialist Elvira Mendez Supervisor-Member Services Section 100% Senior Administrative Clerk Mayra Martinez Member Services Rep: A-F 100% Senior Administrative Clerk Tameekah Ford Member Services Rep: G-I / K-M 100% Senior Administrative Clerk Vincent Pacheco Member Services Rep: N-V 100% Administrative Clerk Maria Lopez Member Services Rep: J, W, Z, Sworn 100% City Attorney Assistant City Attorney Curtis Kidder Board Counsel 25% D. Completed Projects/Meeting Calendar Staff maintains a log of completed projects as well as a calendar of upcoming Board meetings and proposed topics (Attachment A). Submitted by: Paul Makowski Approved by: Steven Montagna 5

6 ATTACHMENT A COMPLETED PROJECTS & UPCOMING MEETINGS CALENDAR COMPLETED PROJECTS: MARCH 16 31, 2018 # STATUS PROJECT 1 Completed JLMBC Minutes Meeting of the February 8, 2018 Meeting 2 Completed JLMBC Report: LAwell Civilian Benefits Program Third-Party Administrator Transition Update 3 Completed JLMBC Report: 2018 Benefits Communications Survey 4 Completed JLMBC Report: 2018 Open Enrollment Data Review 5 Completed JLMBC Report: LIVEwell Wellness Program Update 6 Completed JLMBC Appeals March and April total completed in EBD 7 Completed Catastrophic Illness Cases March and April case processed 8 Completed Anthem PPO Survey Mail Fulfillment and Online Survey Launch 9 Completed Electronic Eligibility File and TCI Process Implementation with Standard Insurance Company 10 Completed ACA Tax Reporting RFP Receipt of Vendor Proposals 11 Completed Understanding Your Vision Benefits Lunchtime Seminar 12 Completed Tax-Advantaged Spending Accounts Request for Proposals (RFP) Performance Exam 13 Completed Employee Assistance Program (EAP) RFP Performance Exam 14 Completed Benefits Third-Party Administrator Transition Workshop #1 and #2 15 Completed Benefits Specialist Position Selection JLMBC UPCOMING MEETINGS CALENDAR MEETING AGENDA ITEM PRESENTATION 17-May LAwell Benefits Plan Design Review and Renewals None JLMBC Report: Employee Assistance Program RFP Evaluation JLMBC Report: Anthem PPO Member Survey Results JLMBC Report: Staffing Reimbursements JLMBC Report: Wellness Program Update JLMBC Report: Monthly Projects & Activities Update 31-May LAwell Benefits Plan Design Review and Renewals None JLMBC Report: Employee Assistance Program Vendor Presentation JLMBC Report: Benefits Trust Fund Review JLMBC Report: Employee Refunds Update 6

7 ATTACHMENT B P.O. Box Van Nuys, CA April 2, 2018 «FNAME» «LNAME» «ADDRESS1» «CITY», «ST» «ZIP» Dear Anthem Blue Cross Member: This letter is to inform you that Southwest Healthcare System-Wildomar (aka Inland Valley Medical Center) is no longer a participating provider in the Anthem Blue Cross network, effective March 31, Anthem Blue Cross physicians who admit to Southwest Healthcare System-Wildomar have been notified of this development and will arrange for admission of Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company members to alternate facilities (please refer to partial list below). Note, the alternate facilities may not be participating in all Anthem networks. Please verify with both your provider and the Anthem Blue Cross website at anthem.com/ca that the alternate facility is participating in your benefit plan s network. Loma Linda University Medical Center Murrieta Menifee Valley Medical Center If you are pregnant, currently undergoing a course of treatment, or if you have a current authorization for health care services, you may be eligible for transition assistance to ensure continuity of care. Please call our toll-free telephone number on your identification card. An Anthem Blue Cross Customer Service representative will be happy to assist you. If you have been receiving care from a health care provider, you may have a right to keep your provider for a designated time period. Please contact the Anthem Blue Cross customer service department, and if you have further questions, you are encouraged to contact the Department of Managed Health Care, which protects HMO/PPO consumers, by telephone at its tollfree number, HMO-2219, or at a TDD number for the deaf or hard of hearing at , or online at If you are enrolled in a point of service (POS) plan or preferred provider organization (PPO) and continue to access Southwest Healthcare System-Wildomar after the expiration date, you may have significantly higher out of pocket costs. Your Evidence of Coverage outlines your coverage for seeking care from a provider who is not part of our network. Also, Customer Service can provide this information. However, enrollees have the availability to access Southwest Healthcare System-Wildomar at in-network benefit levels after the termination date: For any medically necessary services available at the Southwest Healthcare Services-Wildomar, but not available or cannot be scheduled, in a timely manner consistent with good professional practice, at an Alternate Hospital or other innetwork contracted hospital facility within a reasonable geographic distance, including, but not limited to, neonatal ICU, labor/delivery, acute neonatal, and bariatric surgery services, or ; For any medically necssary services available at Southwest Healthcare Services-Wildomar, where an in-network provider holds admitting privileges at the Terminating Hospital and is unable to admit enrollees to an Alternate Hospital or other in-network contracted hospital facility within a reasonable geographic distance, in a timely manner consistent with good professional practice, or, For any medical necessary services at Southwest Healthcare Services-Wildomar when due to insufficient capacity, an enrollee may not be admitted to an Alternate Hospital or other in-network contracted hospital facility within a reasonable geographic distance, in a timely manner consistent with good professional practice. For Blue Distinction-designated for bariatric surgery available at Southwest Healthcare Services-Wildomar, if such services are not available or accessible at a participating network hospital or specialty facility in the Plan s network, the Plan will allow enrollees to receive that service at a non-participating hospital, as appropriate. Emergency medical services do not require pre-authorization regardless of where services are delivered. Members may go to any hospital for emergency services, including Southwest Healthcare System-Wildomar. This coverage will be provided according to your policy benefits. Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association.

8 ATTACHMENT B P.O. Box Van Nuys, CA April 2, 2018 Your enrollment in your Anthem Blue Cross or Anthem Blue Cross Life and Health Insurance Company plan remains the same and is not otherwise affected in any way. If you receive a bill from Southwest Healthcare System-Wildomar that exceeds the amount indicated as the member responsibility on the Explanation of Benefits you receive from Anthem Blue Cross/Anthem Blue Cross Life and Health Insurance Company for services rendered after March 30, 2018, please contact Anthem Blue Cross at the toll free number on your ID card, so that it may be handled appropriately. Your health care needs are very important to us, and we are committed to providing you with exceptional service. Please be assured that your health care coverage will not be interrupted and that this hospital s termination will not result in a change to your covered benefits. Sincerely, Anthem Blue Cross Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association.

9 ATTACHMENT C Kaiser Permanente Pediatric Visit Copayments April 2018 Update The following information is provided in order to clarify and explain the application of copayments required by Kaiser Permanente (Kaiser) for certain types of pediatric visits effective Plan Year How did Kaiser pediatric copays change in 2018? Copayments for certain types of non-preventive pediatric visits have changed to match the copayment collected for an equivalent visit made by an adult. Preventive pediatric care copays have not changed. Why did Kaiser make this change? The Federal Affordable Care Act (ACA) requires non-discrimination in providing access to care under medical insurance providers. In order to comply with ACA Section 1557 non-discrimination provisions, Kaiser changed pediatric care copays for non-preventive services from $0 to $7/$15 (depending on the type of service). The following chart outlines changes in 2018 as compared to 2017: Chemical Dependency Outpatient Program Pediatric Group Visits (5 Dollar(s) OOP Per Day (s)) Pediatric Individual Visits Mental Health Outpatient Pediatric Group Behavioral Analysis Autism Services Pediatric Group Visits Pediatric Individual Behavioral Analysis Autism Services Pediatric Individual Visits Pediatric Mental Health Other Services Non-Preventative Provider Visits $5 Per Visit(s) Based on Age 0-59 $15 Per Visit(s) Based on Age 0-59 $7 Per Visit(s) Based on Age 0-59 $7 Per Visit(s) Based on Age 0-59 $15 Per Visit(s) Based on Age 0-59 $15 Per Visit(s) Based on Age 0-59 $15 Per Visit(s) Based on Age 0-59 Pediatric After Hours/Urgent Care $0 Per Visit(s) $15 Per Visit(s) $7 Per Visit(s) Based on Age 0-59 Pediatric Primary Care Group Visit Pediatric Specialty Care Visit $0 Per Visit(s) $15 Per Visit(s) Pediatric Primary Care Office Visits $0 Per Visit(s) $15 Per Visit(s) Page 1

10 ATTACHMENT C Who do I contact if I have further questions? For pediatric care and copayment questions, you can call Kaiser Member Services from 7:00 a.m. to 7:00 p.m., Monday through Friday, at In addition, the City s onsite Kaiser Member Advocate is available Tuesday through Thursday, 8:00 a.m. 4:00 p.m. at the Employee Benefits Division, located in City Hall, 200 N Spring Street Room 867, Los Angeles CA For other general benefit questions, the LAwell Benefits Service Center is available at , Monday Friday, 8:00 a.m. to 5:00 p.m., or you may also questions to per.empbenefits@lacity.org. Page 2