Payer Roundup—Centene fined for provider-network issues; Nevada to move to private exchange platform

Affordable Care Act highlighted
Nevada’s Silver State Health Insurance Exchange is planning to move from the Healthcare.gov platform to a private enrollment and eligibility solution. (Getty/Ellenmck)

Centene fined $1.5M, gets OK to resume selling ACA plans in Washington

Washington regulators have lifted an order forcing Centene to stop selling individual market plans in the state, provided the insurer pays a fine and fixes issues with its provider networks.

Insurance Commissioner Mike Kreidler first ordered Centene subsidiary Coordinated Care to stop selling plans on Dec. 12. He said the company admitted to not having enough anesthesiologists in certain counties, and its own data revealed its network was also seriously deficient in other categories of providers.

Kreidler noted that his office has been working with Coordinated Care to correct the problems since mid-May, and has received 140 complaints from enrollees about issues accessing in-network providers and receiving surprise medical bills.   

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As part of a consent order that the insurer agreed to on Dec. 15, though, it can resume selling individual market plans if it pays a $1.5 million fine and agrees to fix its network issues. The state will suspend $1 million of the fine if the insurer commits no additional violations over the next two years. (Announcement)

Nevada plans to move to its own ACA exchange

Nevada’s Silver State Health Insurance Exchange is planning to move from the Healthcare.gov platform to a private enrollment and eligibility solution.

In a recent fiscal and operational report, the state said it has been working with the Centers for Medicare & Medicaid Services on a blueprint for the transition, which it estimates will cost $1 million.

Though the report notes that the estimated annual cost of a private platform is $5.8 million per plan year, it said the transition away from Healthcare.gov would still save the exchange approximately $5 million to $6 million a year in user fees paid to CMS.

“This platform will offer Nevada consumers and the exchange a better user experience at a significantly lower cost,” the report said.

Nevada aims to have the private platform operational in time for open enrollment starting Nov. 1, 2019. (Report)

Virginia Democrat faces backlash for Medicaid comments

Ralph Northam, the newly elected Democratic senator from Virginia, is taking heat for expressing a desire to work with Republicans on Medicaid reforms that would move the state’s system to managed care.

Northam made those comments in an interview this weekend with The Washington Post, saying that while he supports Medicaid expansion, he wants to explore ways to control the program’s rising costs. Those might include incentivizing people to make healthy choices and help those who can work to get back in the workforce, he said.

But some Democrats weren’t entirely pleased with those comments. Take Jon Favreau, a former speechwriter for President Barack Obama, who tweeted that Northam must “clarify his Medicaid position as fast as possible or he’ll deserve the wrath he gets from Democrats everywhere.”

A spokesman said Monday that Northam doesn’t want to make Medicaid expansion contingent upon reformimg the program, but does hope to pursue both goals. (The Washington Post)

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