Bill > S604

This bill establishes a "Public Option," a new government-provided health insurance plan, to be offered through the Commonwealth Connector, which is the state's health insurance marketplace. This Public Option will be available to eligible individuals and groups, defined as businesses with 1-50 employees (eligible small groups) and those with 51 or more employees (eligible large groups), starting by January 1, 2016, for individuals and small groups, and by July 1, 2016, for large groups. The plan must meet the same quality and value standards as other health plans that receive a "connector seal of approval" from the Commonwealth Connector Board. The Commonwealth Connector Authority can contract with managed care organizations to administer the Public Option, with a preference for Medicaid managed care organizations initially. The bill also creates a Public Health Insurance Option Trust Fund to finance the operation of the plan and establishes a risk adjustment system to ensure that health plans with sicker enrollees receive payments from plans with healthier enrollees, with certain exemptions for self-insured plans regulated by federal law. Healthcare providers participating in Medicare will automatically be part of the Public Option unless they opt out, and there will be an annual enrollment period for providers to decide on participation. The Commonwealth Connector will set premium rates to cover all costs associated with the plan and will establish payment rates for providers based on Medicare rates, with potential adjustments to ensure adequate provider networks. Finally, the bill mandates that the Commonwealth Connector Board extend its seal of approval to large group plans and offer these plans alongside the Public Option for large groups.