(1) Municipal Employers shall report all
changes to an enrollee's coverage on forms designated by the Commission. Upon
notification from the Commission, Municipal Employers shall be required to
enter on the Commission's eligibility system (MAGIC system), an enrollee's
coverage and/or coverage changes.
(2) The Commission determines the effective
date of enrollees' coverage changes including, but not limited to: individual
to family, family to individual, and cancellation of coverage and shall notify
the Municipal Employer directly via the Premium Deduction Change Notice. The
Municipal Employer shall accept this notice and update its records
accordingly.
(3) Municipal Employers
shall reconcile their entire insured membership on a monthly basis via the
Statement of Verification that is included with the monthly bill and roster.
Municipal Employers shall report any discrepancies to the Commission at a time
determined by the Commission. Late notification of discrepancies to the
Commission may result in a delay in the effective date of insurance coverage
changes.
(4) Any Municipal Employer
that transfers its insureds to the Commission with more than one enrollee
percentage contribution towards a particular individual, family or Medicare
health plan premium shall provide the Commission with enrollment data by
enrollee percentage contribution for said health plan(s). Reporting shall be
monthly, or less frequently as required by the Commission, on a form that will
be provided by the Commission.
(5)
A participating Municipal Employer or its Public Employee Committee may request
data for the sole purpose of determining whether it will continue to
participate after its initial three years, as specified in its executed Public
Employee Committee agreement or order from the three-person arbitration panel.
Requests for such data shall be made in the calendar year in which a given
agreement is open to negotiation, and such requests shall be limited to one
request in the calendar year in which a political subdivision is considering
withdrawing from coverage.
(a) Entities
requesting utilization data should assess the amount of time they will need to
analyze data and conduct negotiations before making a decision about whether to
remain in the Commission. Such entities must submit their requests to the
Commission at least 30 days before the data are to be provided to them to use
in their decision-making process. In a City, the request must be signed by the
City Manager or the Mayor, in a Town by the Town Manager or the Chairman of the
Board of Selectmen, and in a regional school district, by the Chairman of the
Regional School District Committee. For a Public Employee Committee, the
request must be signed by a majority of the representatives of the Public
Employee Committee, or by a weighted majority of representatives of the Public
Employee Committee. The Commission will notify the relevant Municipal Employer
of a data request from a Public Employee Committee.
(b) The Commission will provide the following
data to each requesting entity with more than 50 subscribers:
1. A monthly claims report consisting of the
following data elements:
a. the subscriber
count;
b. the covered lives
count;
c. the total paid medical
claims; and
d. the total paid
prescription drug claims.
2. A yearly large loss report,
i.e., for claimants who have incurred $25,000 or more paid
claims in a given year consisting of the following elements:
a. the de-identified claimant ICD-9 or ICD-10
codes (diagnoses); and
b. the
de-identified claimant total paid claims (medical and prescription drug).
The Commission will provide Protected Health Information to
requesting entities as the Commission's Business Associates subject to the
HIPAA Privacy Rule after each signs the Commission's Business Associate
Agreement (BAA) as specified below. In the event that a Municipal Employer or a
Public Employee Committee both request data in the same year, the Commission
will supply data for the same time period to both entities.
Municipal Employers and Public Employee Committees that have
requested these data will be required to designate a single person to handle
these data, and such persons will be required to sign a BAA in which they agree
not to share these data with other parties. Before receiving these data, the
requesting entities agree to execute a BAA with the Commission in which they
agree that only their single designated person shall handle these data, and
that these data shall not be shared with anyone other than insurance brokers,
benefits consultants, and health plans for the limited purpose of securing bids
for the procurement of health insurance.
Requesting entities wanting Medicare HMO data or fully insured
retiree dental coverage data should use the monthly premium as a substitute for
actual cost. Administrative costs are not included in the data provided.
(6)
On or before January 15, 2013 or any later year, at the request of a Municipal
Employer, the Commission will make available to the Municipal Employer a list
of that Municipal Employer's current members. A Municipal Employer must make
any such request by November 15th of the prior year.
The purpose of this list is to assist the Municipal Employer in meeting its
obligations under M.G.L. c. 32B, § 26.
