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Pensions and Benefits
HEALTH BENEFITS COMMISSION
MEETING MINUTES 2011
 

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Meeting No. 510, Minutes
January 19, 2011, 1:00 PM
State Health Benefits Commission

Adequate notice of this meeting has been provided through the annual notice of the schedule of regular meetings of the Commission filed with and prominently posted in the offices of the Secretary of State.  The 2011 annual meeting schedule was mailed to the Secretary of State, Star Ledger and the Trenton Times on December 10, 2010 and revised notice was sent on January 10, 2011.

The meeting of the State Health Benefits Commission of New Jersey was called to order on Wednesday, January 19, 2011 at 1:38 PM. The meeting was held at the Thomas Edison State College-Prudence Hall, 101 West State Street, Trenton, New Jersey, and was attended by the following members of the Commission and Division staff:

ROLL CALL

Susanne Culliton, Chairperson, representing State Treasurer Andrew P. Sidamon-Eristoff
Sylvia Allen-Ware, representing Commissioner Thomas B. Considine, Department of Banking & Insurance
Robert M Czech, Chair, Civil Service Commission
Patrick Nowlan, Representative for State Government Employees
Dudley Burdge, Representative for Local Government Employees

ALSO PRESENT: 

Rubin Weiner, Deputy Attorney General
David Pointer, Manager, Policy, Planning and Operations
Jean Williamson, Acting Secretary
Barbara Scherer, State Health Benefits Program
Wendy Burns, Horizon Blue Cross Blue Shield New Jersey
Rosemary Middlebrook, Horizon Blue Cross Blue Shield New Jersey
David Perry, Horizon Blue Cross Blue Shield New Jersey
Billie Arroyo, Horizon Blue Cross Blue Shield New Jersey
Dr. Steven Wolinsky, Medical Director Horizon Blue Cross Blue Shield New Jersey
Bhavesh B Modi, RPh, Medco Health Solutions
Angela Pearson, Medco Health Solutions

Resolutions A (Closed Session) and B (Executive Session) – were read in their entirety.

The meeting was delayed because there was no court stenographer. Chairwoman Culliton made a motion to go into Executive Session under Resolution B. Commissioner Nowlan seconded the motion.  All voted in favor. Upon return from Executive Session, Chairwoman Culliton said the Commission would proceed with the meeting without benefit of a court reporter to record a transcript of the meeting so as not to inconvenience the members who were present. The Commission will allow members to present their arguments. Written summaries of their appeal would be mailed as soon as possible following the meeting. After reviewing the summary, the member could respond with comments or additions addressed to Jean Williamson, Acting Secretary of the Commission. The appeals would be heard again at the next SHBC meeting schedule for February 9, 2011 at 10:00, with a court reporter present.  Members are welcome, but not required, to attend the next meeting.  

Meeting No. 509, December 8, 2010: Chairwoman Culliton made a motion to accept the minutes. Commissioner Allen-Ware seconded the motion. All voted in favor.

The following cases, due to HIPAA regulations, are heard in closed session.

Commissioner Burdge made a motion to go into Closed Session under Resolution A.  Commissioner Nowlan seconded the motion.  All voted in favor.

Case# SH011101 - Commissioner Burdge recused himself from this appeal. This tabled Medco appeal concerned a request to fill a prescription for Atacand which is a drug being denied by Medco under the Preferred Drug Step Therapy program. Chairwoman Culliton made a motion to table this appeal.    Commissioner Nowlan seconded the motion.  All voted in favor.

Case #SH011102 This Medco appeal concerned a denial of benefits for expenses for VSL #3 DS Double Strength which was denied under the exclusion for drugs available over the counter.  Commissioner Nowlan made a motion to table this appeal.Chairwoman Culliton seconded the motion.  All voted in favor.

Case #SH011103 (Member Present) – Commissioner Burdge recused himself from this appeal.  This Medco appeal concerned a request to fill a prescription for Actonel which is a drug being denied by Medco under the Preferred Drug Step Therapy program.  The Member provided a copy of her written statement and read it to the Commission. Commissioner Czech asked why the member would not try another drug.  She responded that due to a reaction to a drug that her mother had, she is afraid to try a different drug. Chairwoman Culliton advised that a summary of the presentation and the discussion that took place would be provided to the Member for review.  She also stated that the member could supplement the appeal with any additional information she may have. Chairwoman Culliton made a motion to table this appeal. Commissioner Nowlan seconded the motion. All voted in favor.

Case #SH011104 (Member Present) -This Horizon NJ DIRECT15 appeal concerned a denial of IVF treatment.  The Member and her husband presented their arguments regarding the appeal.  Commissioner Czech asked how long the Member was being treated for infertility and the Member responded when she was 44 years old and then reiterated some of the complications that caused her to stop fertility treatment.  Wendy Burns, Horizon, stated that, based on Department of Banking and Insurance guidance on the State mandate on infertility, all attempts, whether successful or not, are counted. Chairwoman Culliton advised that a summary of the presentation and the discussion that took place would be provided to the Member for review. She also stated that the member could supplement the appeal with any additional information she may have. Chairwoman Culliton made a motion to table this appeal.  Commissioner Nowlan seconded the motion. All voted in favor.

Case #SH011105 (Member Present) - This Horizon NJ DIRECT15 appeal concerned a denial of benefits above the reasonable and customary allowance for surgery. The Member presented her arguments regarding her appeal including that her doctor was in-network but the plastic surgeon that was not in-network was a part of the team her doctor utilizes. She disputed the reasonable and customary charge and the multiple procedures rule. Upon request, Wendy Burns, Horizon, discussed each of the three comparables that the member has provided. Dr. Wolinsky, Medical Director, Horizon, stated the Member had a choice of procedures. He believes there are in-network surgeons that could have performed this surgery. Chairwoman Culliton advised that a summary of the presentation and the discussion that took place would be provided to the Member for review. She also stated that the member could supplement the appeal with any additional information she may have. Chairwoman Culliton made a motion to table this appeal. Commissioner Nowlan seconded the motion. All voted in favor.

Case #SH011106 - A settlement offer was before the Commission in a case involving denial of benefits for an injury deemed work related.  The portion of the lien that was applicable to the SHBP was $420.70 and the settlement proposal was for $227.18.    Chairwoman Culliton made a motion to approve the settlement proposal.  Commissioner Burdge seconded the motion.  All voted in favor.

Case #SH011107 - A settlement offer was before the Commission in a case involving denial of benefits for an injury deemed work related. The lien amount was $9,568.41 and the settlement proposal was for $7,500.00. Chairwoman Culliton made a motion to approve the settlement proposal.  Commissioner Nowlan seconded the motion. All voted in favor.

There being no further appeals, a motion was made to return to open session by Chairwoman Culliton and was seconded by Commissioner Burdge.   All voted in favor.

ISSUES

A. Carrier Updates – No discussion took place because of time constraints.

B. Reimbursement of Surgery Centers – No discussion took place because of time constraints.

There being no further business, Commission Nowlan made a motion to adjourn which was seconded by Chairwoman Culliton.  All voted in favor. The State Health Benefits Commission meeting was adjourned at 3:27 PM.

Respectfully submitted,


Jean M. Williamson, CEBS
Acting Secretary
State Health Benefits Commission

 

 

 

 


Meeting No. 511, Minutes
February 9, 2011, 10:00 AM
State Health Benefits Commission

Adequate notice of this meeting was provided through the annual notice of the schedule of regular meetings of the Commission filed with and prominently posted in the offices of the Secretary of State.  The 2011 annual meeting schedule was mailed to the Secretary of State, Star Ledger and the Trenton Times on December 10, 2010 and revised notice was sent on January 10, 2011.
 
The meeting of the State Health Benefits Commission of New Jersey was called to order on Wednesday, February 9, 2011 at 10:13 AM. The meeting was held at the Division of Pensions and Benefits, 50 West State Street, 1st floor Conference Room, Trenton, New Jersey, and was attended by the following members of the Commission and Division staff:

ROLL CALL

Susanne Culliton, Chairperson, representing State Treasurer Andrew P. Sidamon-Eristoff
Sylvia Allen-Ware, representing Commissioner Thomas B. Considine, Department of Banking & Insurance
Robert M Czech, Chair, Civil Service Commission
Patrick Nowlan, Representative for State Government Employees
Dudley Burdge, Representative for Local Government Employees

ALSO PRESENT: 

Rubin Weiner, Deputy Attorney General
David Pointer, Manager, Policy, Planning and Operations
Jean Williamson, Acting Secretary
Barbara Scherer, State Health Benefits Program
Wendy Burns, Horizon Blue Cross Blue Shield New Jersey
Rosemary Middlebrook, Horizon Blue Cross Blue Shield New Jersey
David Perry, Horizon Blue Cross Blue Shield New Jersey
Billie Arroyo, Horizon Blue Cross Blue Shield New Jersey
Jennifer Kovaly, Horizon Blue Cross Blue Shield New Jersey
Dr. Steven Wolinsky, Medical Director Horizon Blue Cross Blue Shield New Jersey
Bhavesh B Modi, RPh, Medco Health Solutions
Angela Pearson, Medco Health Solutions

Resolutions A (Closed Session) and B (Executive Session) – were read in their entirety.

Meeting No. 510, January 19, 2011:   Chairperson Culliton made a motion to accept the minutes. Commissioner Czech seconded the motion.  All voted in favor.

The following cases, due to HIPAA regulations, are heard in closed session.

Chairperson Culliton made a motion to go into Closed Session under Resolution A.  Commissioner Burdge seconded the motion.  All voted in favor.

Case# SH021101 - This tabled Medco appeal concerned a denial of benefits for expenses for VSL #3 DS Double Strength.  Chairperson Culliton made a motion to deny this appeal since the drug is available over-the-counter and is therefore specifically excluded from coverage under the Prescription Drug Plan.  Commissioner Czech seconded the motion.  Approved (Vote 4: 0: 1, Commissioner Burdge abstained).

Case #SH021102 – This tabled Medco appeal concerned a denial of benefits for Actonel under the Preferred Drug Step Therapy program.   Commissioner Burdge recused himself from this appeal.  Jean Williamson, Acting Secretary, advised the Commission she did not receive a response from the member concerning the summary of the previous meeting’s proceeding.  Chairperson Culliton made a motion to deny this appeal since the drug has shown no added benefit regarding efficacy or side effects over lower cost therapeutic alternatives and is therefore excluded from coverage under the Prescription Drug Plan.  Commissioner Czech seconded the motion.  All voted in favor.

Case #SH021103 (Member Present) – This tabled Horizon NJ DIRECT15 appeal concerned a denial of benefits for IVF treatment.  An explanation of the policy for IVF treatment was given by Horizon.  A discussion took place between the member, her spouse and the Commissioners.  Commissioner Czech made a motion to deny this appeal on the basis that the member was 46 years of age or older and therefore IVF services are excluded under the plan.  Chairperson Culliton seconded the motion.  All voted in favor.

Case #SH021104 - This tabled Horizon NJ DIRECT15 appeal concerned a denial of benefits above the reasonable and customary allowance for surgery.   A brief discussion took place between the Commissioners and Wendy Burns of Horizon Blue Cross Blue Shield of New Jersey concerning the availability of in-network doctors to perform the services at issue.  Chairperson Culliton made a motion deny this appeal based on the claims being accurately paid for out-of-network services.   Commissioner Nowlan seconded the motion.  All voted in favor.

Case #SH021105 - This tabled Medco appeal concerned a denial of benefits for Atacand under the Preferred Drug Step Therapy program.   Commissioner Burdge recused himself from this appeal.  Jean Williamson, Acting Secretary, advised the Commission she spoke to the member’s physician.  He said the member has been on Atacand for twelve years. The physician indicated there is no medical reason why the member cannot try another prescription drug in the same class.  Commissioner Czech made a motion to deny this appeal since the drug has shown no added benefit regarding efficacy or side effects over lower cost therapeutic alternatives and is therefore excluded from coverage under the Prescription Drug Plan.   Chairperson Culliton seconded the motion.  Approved (Vote 3: 0: 1, Commissioner Nowlan abstained).

Case#SH021106 - (Member attended via telephone) - This Medco appeal concerned a denial of benefits for Miralax.  A discussion took place between the Member, Commissioners and Bhavesh B Modi, RPh, Medco Health Solutions.   The Member stated she could not afford to purchase Miralax over-the-counter.  Commissioner Allen-Ware suggested the member contact the manufacturer to inquire if she would be eligible for a discount.  Commissioner Czech made a motion to deny this appeal because the drug is available over-the-counter and is specifically excluded from coverage under the Prescription Drug Plan.. Chairperson Culliton seconded the motion.  Approved (Vote 3: 2: 0, Commissioner Nowlan and Burdge voted nay).

Case#SH021107 - This Medco appeal concerned a denial of benefits for Loperamide.  Commissioner Czech made a motion to deny this appeal because the drug is available over-the-counter and is specifically excluded from coverage under the Prescription Drug Plan.Chairperson Culliton seconded the motion.  Approved (Vote 3: 2: 0, Commissioner Nowlan and Burdge voted nay).

Case#SH021108 - This Medco appeal concerned a denial of benefits for Vaniqa.  Chairperson Culliton made a motion to deny this appeal because the drug is used for cosmetic purposes and is specifically excluded from coverage under the Prescription Drug Plan, but to permit reimbursement for up to 90 days for costs incurred for Vaniqa during calendar year 2010 because the drug was previously paid for by Caremark .  Commissioner Czech seconded the motion.  All voted in favor.

Case#SH021109 - This Medco appeal concerned a request for a lower co-payment for Olux-E and Solodyn for her son.  Chairperson Culliton made a motion to deny this appeal because the plan does not allow any exceptions for non-formulary co-payment reductions under the Retiree Prescription Drug Plan.  Chairperson Culliton requested that the Member be notified that both drugs are available in generic form at a lower co-payment.  Commissioner Nowlan seconded the motion.  All voted in favor.

 Case #SH021110 –  This Medco appeal concerned a denial of benefits for Cialis beyond four pills per month/twelve pills in a 3 month period.  Commissioner Burdge made a motion to deny this appeal based on the monthly quantity limits currently applicable to erectile dysfunction drugs.  Commissioner Nowlan seconded the motion.  All voted in favor.

Case#SH021111 -  This Medco appeal concerned a denial of benefits for Tri-Luma. Chairperson Culliton made a motion to deny this appeal because the drug is used for cosmetic purposes and is specifically excluded from the Prescription Drug Plan.   Commissioner Czech seconded the motion.  All voted in favor.

Case #SH021112 - The Member made a request that the denial of benefits for the prescription drug Vaniqa be forwarded to the Office of Administrative Law (OAL) for a hearing.  Chairperson Culliton made a motion to deny this request for a hearing at the OAL and to issue a Final Administrative Determination.  Commissioner Czech seconded the motion.  All voted in favor.

Case #SH02113 – A settlement offer was before the Commission in a case involving denial of benefits for an injury that was the result of an incident that was deemed work related.  The lien amount was $20,966.08 and the proposal was for $16,772.86.  Chairperson Culliton made a motion to accept the settlement proposal.  Commissioner Nowlan seconded the motion.  All voted in favor.

There being no further appeals, Commissioner Nowlan made a motion to return to open session and it was seconded by Commissioner Allen-Ware.  All voted in favor.

ISSUES

  1. Carrier Updates – None

  2. Reimbursement of Surgery Centers:  David Perry, Horizon BCBSNJ, gave a historical background and an overview of the reimbursement rates for non-participating surgery centers.  Chairperson Culliton made a motion to go into Executive Session under Resolution B.  Commissioner Burdge seconded the motion and all voted in favor.  Upon return from Executive Session, Chairperson Culliton asked Mr. Perry if he could provide a written summary of his presentation.  David Pointer asked Mr. Perry regarding reimbursement for unlicensed surgery centers.  Mr. Perry agreed to follow up within a few days.  Chairperson Culliton made a motion to table this matter in order to receive additional advice from counsel.  Commissioner Burdge seconded the motion and all voted in favor.

There being no further business, Chairperson Culliton made a motion to adjourn which was seconded by Commissioner Czech. All voted in favor.  The State Health Benefits Commission meeting was adjourned at 12:37 PM.

Respectfully submitted,


Jean M. Williamson, CEBS
Acting Secretary
State Health Benefits Commission

 

 

 

 


Meeting No. 512
Minutes
March 9, 2011
10:00 AM
State Health Benefits Commission

Adequate notice of this meeting has been provided through the annual notice of the schedule of regular meetings of the Commission filed with and prominently posted in the offices of the Secretary of State.  The 2011 annual meeting schedule was mailed to the Secretary of State, Star Ledger and the Trenton Times on December 10, 2010 and revised notice was sent on January 10, 2011.
.
The meeting of the State Health Benefits Commission of New Jersey was called to order on Wednesday, March 9, 2011 at 10:40 AM.  The meeting was held at the Division of Pensions and Benefits, 50 West State Street, 1st floor Conference Room, Trenton, New Jersey, and was attended by the following members of the Commission and Division staff:

ROLL CALL

Susanne Culliton, Chairperson, representing State Treasurer Andrew P. Sidamon-Eristoff
Sylvia Allen-Ware, representing Commissioner Thomas B. Considine, Department of Banking & Insurance
Robert M Czech, Chair, Civil Service Commission
Patrick Nowlan, Representative for State Government Employees
Dudley Burdge, Representative for Local Government Employees

ALSO PRESENT: 

Rubin Weiner, Deputy Attorney General
David Pointer, Manager, Policy, Planning and Operations
Jean Williamson, Acting Secretary
Barbara Scherer, State Health Benefits Program
Wendy Burns, Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ)
Rosemary Middlebrook, Horizon BCBSNJ
David Perry, Horizon BCBSNJ
Steven Wolinsky, M.D., Medical Director, Horizon BCBSNJ
Katherine Impellizzeri, Aetna Health Plan
Patrick Currie, Aetna Health Plan
Dr. Mark Friedlander, Medical Director Aetna Health Plan
Dr. Phyllis Greenwald, Medical Director Aetna Health Plan

Resolutions A (Closed Session) and B (Executive Session) – were read in their entirety.

Meeting No. 511, February 9, 2011: Chairwoman Culliton made a motion to accept the minutes. Commissioner Burdge seconded the motion. All voted in favor.

The following cases, due to HIPAA regulations, are heard in closed session.

Commissioner Burdge made a motion to go into Closed Session under Resolution A. Commissioner Allen-Ware seconded the motion.  All voted in favor.

Case# SH031101 This previously postponed Aetna appeal concerned a denial of benefits for Transcranial Magnetic Stimulation (TMS) therapy. Dr. Mark Friedlander, Medical Director Aetna, advised the Commission that TMS therapy is considered a new therapy for Major Depressive Disorder.  Dr. Friedlander gave background on TMS therapy and on how Aetna’s TMS Clinical Policy’s has been reviewed.  Upon review of updated literature, Aetna concluded TMS therapy is experimental because the value and effectiveness of the therapy has not been established. Commissioner Czech made a motion to deny this appeal because TMS therapy is considered to be experimental and investigational for the diagnosis and treatment of the member’s condition. Experimental and investigational therapies are exclusions under the plan. Chairwoman Culliton seconded the motion. Approved (Vote 4: 0: 1, Commissioner Allen-Ware abstained).

Case #SH031102 (Member and Fiancée Present) – This Horizon BCBSNJ -NJ DIRECT15 appeal concerned a denial of benefits for ambulance transport from the emergency room to the member’s residence.  The Member and Fiancée presented an overview of the appeal. Wendy Burns, Horizon BCBSNJ, stated non-emergency ambulance transport is not a covered benefit. Furthermore, the record shows that the ambulance transportation to the Member’s residence when leaving the hospital was the Patient’s choice. The Member’s Fiancée advised that no other options were provided for transportation since they didn’t have a car.  A discussion ensued in which Horizon BCBSNJ representatives were asked to review their records and send a copy of the ambulance bill to the member for her records.  Horizon BCBSNJ representatives also agreed to contact the company that provided the ambulance transport to confirm that the member had not been overcharged.  In addition, Horizon BCBSNJ representatives agreed to speak with the hospital to advise that ambulance transportation is not a covered benefit for “non-emergency” situations and that they should not promote the service to members.  Chairwoman Culliton made a motion to deny this appeal based on non-emergency ambulance service being exclusion under the plan. Commissioner Czech seconded the motion. Approved (Vote 4: 0: 1, Commissioner Nowlan abstained).

Case #SH031100 - Final Administrative Determination (FAD) – Chairperson Culliton made a motion to accept the FAD draft concerning the denial of benefits for the prescription drug Vaniqa Cream.  Commissioner Czech seconded the motion. All voted in favor.

Case #SH031103 – A settlement offer was before the Commission in a case involving denial of benefits for an injury deemed work related. The lien amount was $6,187.81 and the proposed settlement amount was $2,000.00.  Chairwoman Culliton made a motion to authorize Socrates, a Horizon BCBSNJ recovery subcontractor, to negotiate a resolution that calls for recovery of $3,093.91.  Commissioner Nowlan seconded the motion. All voted in favor.

Case #SH031104(Attorney present) A settlement offer was before the Commission in a case involving a denial of benefits for expenses for treatment at Williamsburg Place/Farley Center and at Little Hill Foundation/Alina Lodge. A discussion took place between the Commission and the member’s attorney.  Commissioner Nowlan made a motion to go into Executive Session under Resolution B.   Commissioner Allen-Ware seconded the motion. All voted in favor. Upon return from Executive Session, Chairwoman advised that the settlement amount offered was larger than the amount the Traditional Plan would have paid based on plan benefit design. The Commission directed DAG Ignatowitz to contact Magellan and request additional information. Chairwoman Culliton made a motion to table the settlement proposal until April. Commissioner Burdge seconded the motion. All voted in favor.

Case #SH031105 - A settlement offer was before the Commission in a case involving denial of benefits for an injury deemed work related. The lien amount was $36,670.21 and the proposed settlement amount was $18,335.00. Chairwoman Culliton made a motion to authorize Socrates, a Horizon recovery subcontractor, to negotiate a resolution that calls for recovery of $27,500 and future knee related claims would not automatically be excluded as being work related but are still subject to review and payment in accordance with the terms of the contract. Commissioner Nowlan seconded the motion. All voted in favor.

Case#SH031106 - A settlement offer was before the Commission in a case involving denial of benefits for an injury deemed work related. The lien amount was $28,215.10 and the proposed settlement amount was $1,000.00. Chairwoman Culliton made a motion to accept the settlement amount of $1,000.00. Commissioner Czech seconded the motion. All voted in favor.

Case#SH031107 - A settlement offer was before the Commission in a case involving denial of benefits for an injury deemed work related.  The lien amount was $5,758.75 and the proposed settlement amount was $3,750.00.  Chairwoman Culliton made a motion to accept the settlement amount of $3,750.00. Commissioner Czech seconded the motion. All voted in favor.

Case#SH031108 - A settlement offer was before the Commission in a case involving denial of benefits for an injury deemed work related. The lien amount was $5,246.12 and the proposed settlement amount was $2,623.06. Chairwoman Culliton made a motion to accept the settlement amount of $2,623.06. Commissioner Nowlan seconded the motion. All voted in favor.

There being no further appeals, a motion was made to return to open session by Chairwoman Culliton, seconded by Commissioner Burdge. All voted in favor.

ISSUES

A. Carrier Updates –

David Pointer announced that two hospitals, UMDNJ and Trinitas, were terminating from Aetna’s network, though negotiations are still underway.

David Perry, Horizon BCBSNJ advised the Commission about the implementation of a Pain Management Program beginning April 1, 2011. All Pain Management services will require prior authorization in order for the claims to be paid.  If the member does not get prior authorization for the services, no benefits will be paid.  He estimated that this will result in a 20% - 30% cost savings to the plan. Commissioner Burdge requested the Commission get a copy of the notification letters that were being sent to members.

There being no further business, Commissioner Nowlan made a motion to adjourn which was seconded by Chairwoman Culliton. All voted in favor. The State Health Benefits Commission meeting was adjourned at 1:04 PM.

Respectfully submitted,


Jean M. Williamson, CEBS
Acting Secretary
State Health Benefits Commission

 

 

 

 


Meeting No. 513
Minutes
April 13, 2011, 10:00 AM
State Health Benefits Commission

Adequate notice of this meeting has been provided through the annual notice of the schedule of regular meetings of the Commission filed with and prominently posted in the offices of the Secretary of State. The 2011 annual meeting schedule was mailed to the Secretary of State, Star Ledger and the Trenton Times on December 10, 2010 and a revised notice was sent on January 10, 2011. The meeting of the State Health Benefits Commission of New Jersey was called to order on Wednesday, April 13, 2011 at 10:12 AM. The meeting was held at the Division of Pensions and Benefits, 50 West State Street, 1st floor Conference Room, Trenton, New Jersey, and was attended by the following members of the Commission and Division staff:

ROLL CALL

Susanne Culliton, Chairperson, representing State Treasurer Andrew P. Sidamon-Eristoff
Sylvia Allen-Ware, representing Commissioner Thomas B. Considine, Department of Banking & Insurance
Robert M Czech, Chair, Civil Service Commission
Patrick Nowlan, Representative for State Government Employees (via telephone – left the meeting at 11:30)
Dudley Burdge, Representative for Local Government Employees

ALSO PRESENT: 

Rubin Weiner, Deputy Attorney General
David Pointer, Manager, Policy, Planning and Operations
Barbara Scherer, State Health Benefits Program
Edward W. Fox, Aon Hewitt Consultants
Mike Morfe, Aon Hewitt Consultants
Dave Perry, Horizon Blue Cross Blue Shield New Jersey
Angela Pearson, Medco Health Solutions
Bhavesh B Modi, RPh, Medco Health Solutions

Resolutions A (Closed Session) and B (Executive Session) – were read in their entirety.

Meeting No. 512, March 9, 2011: Chairwoman Culliton made a motion to accept the minutes. Commissioner Burdge seconded the motion.  Approved (4 : 0 : 1, Commissioner Nowlan abstained).

Meeting No. 512 Executive Minutes, March 9, 2011: Chairwoman Culliton made a motion to accept the minutes. Commissioner Czech seconded the motion.  Approved (4 : 0 : 1, Commissioner Nowlan abstained).

Chairwoman Culliton moved to go out of order and to proceed with all matters that were open to the public.

ISSUES

  1. Active Employee Dental Expense Plan: David Pointer gave an overview of his memo to the State Health Benefits Commission dated April 13, 2011 which addressed a recommended change in the benefit design for the Active Employee Dental Expense Plan from a passive PPO to a true PPO. The Retiree Dental Expense Plan implemented this change effective January 1, 2010. Based on claims paid through September 30, 2010, the change has reduced retiree claim costs approximately 11 percent. Since the savings have been substantial in the retiree plan, Mr. Pointer recommended the Active Employee Dental Expense Plan also be changed from a passive PPO to a true PPO plan effective January 1, 2012. This is projected to reduce plan costs and enrolled employees will benefit from the associated premium reduction, since they pay 50 percent of the cost of the plan.  Under the current passive PPO benefit design, employees have the same coinsurance for both in-network and out-of-network providers. The change in the plan design will not increase costs to members who use the services of in-network providers. Costs will increase for members when using out-of-network providers. Commissioner Burdge thought the State participation rate was very high and asked what the participating rate was for local employers.  Mr. Pointer did not have that information available but agreed to provide the number of local employers participating in the Dental Expense Plan.  Commissioner Burdge suggested that voting should be postponed to see if the unions needed to negotiate this change. Commissioner Czech made a motion to approve a change to the Active Employee Dental Expense Plan from a passive PPO to a true PPO effective January 1, 2012. Chairwoman Culliton seconded the motion.  Approved. (Vote 3: 2: 0, Commissioners Burdge and Nowlan voted Nay).

  2. Employer Group Waiver Plan: Edward Fox and Michael Morfe, Aon Hewitt Consulting, gave an overview of a proposal to integrate the prescription drug benefit through Medicare using an Employer Group Waiver Plan (EGWP).  The SHBP/SEHBP currently takes advantage of the Retiree Drug Subsidy program for Medicare retirees. Mr. Fox distributed two handouts entitled: 1) Phase-Out of Medicare Part D Coverage Gap and 2) Medicare Integration Methods – Prescription Drug Benefit.  Changes introduced by Federal Health Care Reform created an opportunity for plan sponsors to redesign the mechanics of their group based Medicare-eligible retiree prescription drug plan to reduce program cost. The optimal financial approach (with no plan design changes) is the combination of an EGWP and a Medicare Secondary Plan Option (MSP), known as EGWP Plus Wrap.  More detailed information will be provided at the next Commission meeting.  Commissioner Burdge asked if the information could be provided to the Commissioners before the meeting.

  3. SHBP Retiree Wellness Program Report:  David Pointer walked through the SHBP Retiree Wellness Program report provided by Aon Hewitt Consultants dated March 16, 2011. 

    Background:  The State Health Benefits Commission is required by legislation to offer a wellness program for certain eligible retirees. The objective of the SHBP Retiree Wellness Program (RWP), which was implemented in July 2007, is to improve the health of the retiree population by encouraging healthy behavior and to reward eligible retirees who fully participate with a waiver of their required contribution for health care coverage, which otherwise would amount to 1.5% of their pension.

    Eligible Population: SHBP retirees who attain 25 years of service after June 30, 2007 or who retired on a disability retirement on or after August 1, 2007 are eligible for the RWP. Spouses and covered dependents are not required to participate. As of December 2010, approximately 3,100 SHBP retirees had been identified as eligible for the Program.
  4. SHBP Retiree Wellness Plan Participation
    (Data from Plan Inception (7/1/07) through End of 2010)

    Vendor

    # of Retirees
    Eligible

    # of
    Participants

    %
    Participation

    Horizon

    2,143

    1,052

    49%

    Aetna

    869

    400

    46%

    CIGNA

    121

    32

    26%

    Total

    3,133

    1,484

    47%

    Summary

    The relatively-small number of retirees for a relatively-short period of time makes it difficult to determine if the program has in fact improved member health and reduced plan costs. We expect that later in Plan Year 2011 a more-detailed review of actual claim costs for the group involved will be conducted that may shed some light on this area.

    Aon Hewitt firmly believes a comprehensive wellness program for both actives and retirees is a crucial element of a long-term health care strategy designed to improve health and reduce SHBP/SEHBP long-term costs. This type of strategy is currently under consideration by the Division.

    Commissioner Burdge asked why CIGNA health plan participate is so low.  Mr. Pointer said it was unclear why the CIGNA retiree participation was lower than other vendors. 

  5. Ambulatory Surgery Center (ASC) Payment Policy:  This issue was tabled for discussion at the March Commission meeting.  The Division of Law received information from Horizon; however the Division required additional information in order to make a recommendation to the Commission.  Chairwoman Culliton asked if there wasn’t some urgency to this issue.  Dave Perry, Horizon stated the urgent issue in the matter is the pending settlement proposals.  Chairperson Culliton made a motion to go into Executive Session under Resolution B.  Commissioner Burdge seconded the motion and all voted in favor.  Upon returning from Executive Session, Chairwoman Culliton asked Mr. Perry to pursue a settlement with the two ASCs at issue for the Commission’s review.  The settlement is to stipulate that the members will not be balanced billed and the claims in question will be considered paid in full and that the settlement was contingent on the Commission’s approval.

  6. Carrier Updates.  David Pointer announced Newton Hospital is returning to Horizon’s network effective May 1, 2011.  He also stated there is nothing new on UMDNJ and Trinitas terminating from Aetna’s network; negotiations are still underway.

    DAG Weiner announced that an arbitrator had recently determined that implementation of the Preferred Drug Step Therapy program was in violation of certain provisions of the State’s collective negotiations agreement with CWA. The AG’s office was working with the Division to determine the next steps in either moving to vacate the decision or, if not, in implementing the decision.

The following cases, due to HIPAA regulations, are heard in closed session.

Commissioner Burdge made a motion to go into Closed Session under Resolution A.  Commissioner Allen-Ware seconded the motion.  All voted in favor.

Commissioner Nowlan left the meeting at 11:30, before the following appeals were heard.

Case# SH041101 This Division appeal concerned a denial to reinstate retired group health benefits coverage for a member who did not enroll in Medicare when first eligible.  David Pointer advised the Commission an audit determined the member did not enroll in Medicare timely. The member was informed in his retirement offering letter dated May 14, 2003 and the application he signed to enroll in the Program of the requirement of enrolling in Medicare. The member became eligible for Medicare in 2005; however, he did not enroll at that time.  Chairwoman Culliton made a motion to deny this appeal based on the member not being enrolled in Medicare B and that the SHBP cannot pay claims that should be paid by Medicare.  Commissioner Czech seconded the motion.  Approved (Vote 3: 0: 1, Commissioner Burdge abstained).

Case #SH041102 – A settlement offer was before the Commission in a case involving denial of benefits for an injury deemed work related.  The lien amount was $3,849.83 and the proposed settlement amount was $2,000.00.  Chairwoman Culliton made a motion to authorize Socrates to negotiate a resolution that calls for a minimum recovery of $2,750.00. Commissioner Czech seconded the motion.  Approved (Vote 4: 0: 0.)

Case #SH041103 – This tabled settlement offer was before the Commission in a case involving denial of benefits for expenses for treatment at Williamsburg Place/Farley Center and at Little Hill Foundation/Alina Lodge.  David Pointer asked Deputy Attorney General (DAG) Rubin Weiner if information was received from DAG Ignatowitz.  DAG Weiner said additional information is still needed before his office could make a recommendation regarding the settlement.  Chairwoman Culliton made a motion to table the settlement proposal.Commissioner Czech seconded the motion.  Approved (Vote 4: 0: 0.)

Case #SH041104 - A settlement offer was before the Commission in a case involving denial of benefits for an injury deemed work related.  Commissioner Burdge recused himself from this settlement proposal.  The lien amount was $7,069.75 and the proposed settlement amount was $1,000.00.  Chairwoman Culliton made a motion to accept the settlement amount of $1,000.00.  Commissioner Czech seconded the motion.  Approved (Vote 3: 0: 0.)

There being no further appeals, a motion was made to return to open session by Commissioner Czech, seconded by Chairwoman Culliton. All voted in favor.

There being no further business, Commissioner Czech made a motion to adjourn which was seconded by Commissioner Burdge.  All voted in favor.  The State Health Benefits Commission meeting was adjourned at 12:09 PM.

Respectfully submitted,


David J. Pointer, CEBS
Acting Secretary
State Health Benefits Commission

 

 

 


Meeting No. 514
Minutes
May 11, 2011, 10:00 AM
State Health Benefits Commission

Adequate notice of this meeting has been provided through the annual notice of the schedule of regular meetings of the Commission filed with and prominently posted in the offices of the Secretary of State. The 2011 annual meeting schedule was mailed to the Secretary of State, Star Ledger, and the Trenton Times on December 10, 2010 and a revised notice was sent on January 10, 2011. The meeting of the State Health Benefits Commission of New Jersey was called to order on Wednesday, May 11, 2011 at 10:25 AM. The meeting was held at the Division of Pensions and Benefits, 50 West State Street, 1st floor Conference Room, Trenton, New Jersey, and was attended by the following members of the Commission and Division staff:

ROLL CALL

Susanne Culliton, Chairperson, representing State Treasurer Andrew P. Sidamon-Eristoff
Sylvia Allen-Ware, representing Commissioner Thomas B. Considine, Department of Banking & Insurance
Robert M Czech, Chair, Civil Service Commission
Patrick Nowlan, Representative for State Government Employees
Dudley Burdge, Representative for Local Government Employees (via telephone 10:25 am to 11:12 am, at which time he arrived in person)

ALSO PRESENT:

Rubin Weiner, Deputy Attorney General
David Pointer, Manager, Policy, Planning and Operations
Jean Williamson, Acting Secretary
Barbara Scherer, State Health Benefits Program
Erika Castro, CIGNA Healthcare
Daniel Nicoll, M.D., CIGNA Healthcare
Dave Perry, Horizon Blue Cross Blue Shield of New Jersey
Wendy Burns, Horizon Blue Cross Blue Shield of New Jersey
Rosemary Middlebrook, Horizon Blue Cross Blue Shield of New Jersey
Susan Rizzni, Horizon Blue Cross Blue Shield of New Jersey
Louis Parrott, Medical Director, Magellan Health Services

Resolutions A (Closed Session) and B (Executive Session) – were read in their entirety.

Meeting No. 513, April 13, 2011: Chairwoman Culliton made a motion to accept the minutes. Commissioner Czech seconded the motion. Approved (4: 0 : 1, Commissioner Nowlan abstained).
Jean Williamson announced the Public Session of the SHBC meeting would be first on the agenda.

ISSUES

A. Ambulatory Surgery Centers (ASC) Payment Policy: The Division of Law received a written summary from Horizon BCBSNJ outlining a payment policy for ASCs; however the Division of Law was not ready to make a recommendation to the Commission. Commissioner Nowlan made a motion to table the ASCs Payment Policy. Commissioner Allan-Ware seconded the motion. Approved (Vote 5: 0: 0)

B. Authorization for Horizon to Settle Claims with the ASCs: Chairwoman Culliton made a motion to go into Executive Session under Resolution B. Commissioner Nowlan seconded the motion. Approved (Vote 5: 0: 0). Upon returning from Executive Session, Chairwoman Culliton made a motion to recognize Horizon’s authority to settle claims with two ASCs providing the following conditions are met: (1) settlement is not lower than what would have been paid under the plan’s benefits, (2) members will not be balanced billed, and (3) as a result of this negotiation, the ASC will become an in-network provider. Commissioner Czech seconded the motion. Approved (Vote 4: 0: 1, Commissioner Allen-Ware abstained).

C. Carrier Updates: None

D. Employer Updates: FYI: The 2011 year-to-date Report for New Local Government Employers and Termination of Local Government Employers was handed out at the beginning of the meeting. There was no discussion.

The following cases, due to HIPAA regulations, are heard in closed session.

Chairwoman Culliton made a motion to go into Closed Session under Resolution A. Commissioner Burdge seconded the motion. All voted in favor.

Case# SH051101 – (Member Present) - This CIGNA appeal concerned a denial of benefits for expenses for Stance Control Orthoses deemed investigational by CIGNA. The member gave a brief overview of his appeal. Dr. Daniel Nicoll, Medical Director, CIGNA, gave a summary of CIGNA’s position. Commissioner Burdge made a motion to table this appeal to allow the Division time to verify if the two other SHBP carriers cover the Stance Control Orthoses. Commissioner Nowlan seconded the motion. Approved (Vote 5: 0: 0).

Case# SH051102 – (Member Present with Philip Yucht, LCSW) - This Horizon NJ DIRECT15/Magellan appeal concerned the level of reimbursement for an out-of-network provider. Commissioner Allen-Ware recused herself from this appeal. Mr. Yucht, on behalf of the member, gave a short presentation of the appeal. He stated based on the statute, N.J.S.A. 52:14-17.29 the member is entitled to receive 70% of the reasonable and customary (R&C) charge. The R&C charge is based on the 90th percentile of the usual, customary and reasonable fee schedule determined by PHCS in accordance with the statute. He stated since May 2009, the allowable rate for mental health services provided by a LCSW has decreased significantly. Dave Perry, Horizon BCBSNJ, stated the reimbursement structure was changed at that time because Horizon BCBSNJ determined the PHCS data does not accurately or adequately reflect behavioral health claims data. The professional level of the rendering provider is not used in the fee schedule. Commissioner Czech made a motion to deny this appeal since the Commission previously approved reimbursement levels based on the PHCS fee schedule taking into account the professional level of the provider. Chairwoman Culliton seconded the motion. Commissioner Burdge stated, the statute is very clear on what the rates are. Motion Tied. (Vote 2: 2: 0, Commissioners Burdge and Nowlan voted nay). Chairwoman Culliton stated in the past the Commission has denied similar appeals. Chairwoman Culliton made a motion to table this appeal to allow Commissioner Allen-Ware time to find a representative to vote in her place on this matter. Commissioner Czech seconded the motion. Approved (Vote 2: 1: 1, Commissioner Burdge abstained and Commissioner Nowlan voted nay.)

Case #SH051103 – A settlement offer was before the Commission in a case involving denial of benefits for an injury deemed work related. The lien amount was $1,412.51 and the proposed settlement amount was $1,000.00. Since the memo from Socrates was missing from the file, there was no recommendation to the Commission. Commissioner Czech made a motion to table this settlement until the information was obtained. Commissioner Nowlan seconded the motion. All voted in favor.

Case #SH051104 - A settlement offer was before the Commission in a case involving denial of benefits for an injury deemed work related. The lien amount was $10,470.98 and the proposed settlement amount was $4,400.00. Chairwoman Culliton made a motion to approve this settlement proposal, Commissioner Nowlan seconded the motion. All voted in favor.

Case #SH051105 - A settlement offer was before the Commission in a case involving denial of benefits for an injury deemed work related. The lien amount was $14,173.51 and the proposed settlement amount was $7,086.75. Chairwoman Culliton made a motion to table this case and asked Horizon BCBSNJ to determine if no additional treatment was authorized and if there was a settlement made previously. Commissioner Czech seconded the motion. All voted in favor.

Case #SH051106 – This tabled settlement offer was before the Commission in a case involving a denial of benefits for expenses for treatment at Williamsburg Place/Farley Center and at Little Hill Foundation/Alina Lodge. Chairwoman Culliton made a motion to go into Executive Session under Resolution B. Commissioner Burdge seconded the motion and all voted in favor. Upon return from Executive Session, Chairwoman Culliton made a motion to make an offer in accordance with the first option on page 4 of DAG Ignatowitz’s memo of May 6, 2011. Commissioner Nowlan seconded the motion and all voted in favor.

Case #SH051107 – This Horizon/NJ DIRECT15 appeal for reimbursement of an Embryo transfer was forwarded from the Appellate Division to remand to the Office of Administrative Law (OAL). – After a brief discussion, Chairperson Culliton made a motion to forward this appeal to (OAL). Commissioner Nowlan seconded the motion. Approved (Vote 4: 1: 0, Commissioner Czech voted nay).

There being no further appeals, a motion was made to return to open session and to adjourn by Commissioner Nowlan and seconded by Commissioner Burdge. All voted in favor.
The State Health Benefits Commission meeting was adjourned at 1:11 PM.

Respectfully submitted,


Jean M. Williamson, CEBS
Acting Secretary
State Health Benefits Commission

 

 


 


Meeting No. 515
Minutes
July 13, 2011, 1:00 PM
State Health Benefits Commission

Adequate notice of this meeting has been provided through the annual notice of the schedule of regular meetings of the Commission filed with and prominently posted in the offices of the Secretary of State. The 2011 annual meeting schedule was mailed to the Secretary of State, Star Ledger and the Trenton Times on December 10, 2010 and revised notices were sent on January 10, 2011 and July 11, 2011. The meeting of the State Health Benefits Commission of New Jersey was called to order on Wednesday, July 13, 2011 at 1:25 PM. The meeting was held at the Division of Pensions and Benefits, 50 West State Street, 1st floor Conference Room, Trenton, New Jersey, and was attended by the following members of the Commission and Division staff:

ROLL CALL

Susanne Culliton, Chairperson, representing State Treasurer Andrew P. Sidamon-Eristoff
Sylvia Allen-Ware, representing Commissioner Thomas B. Considine, Department of Banking & Insurance (except appeal #071102)
Thomas Gallagher, representing Commissioner Thomas B. Considine, Department of Banking & Insurance (appeal #071102 only)
Robert M Czech, Chair, Civil Service Commission
Patrick Nowlan, Representative for State Government Employees
Dudley Burdge, Representative for Local Government Employees

ALSO PRESENT: 

Rubin Weiner, Deputy Attorney General
David Pointer, Manager, Policy, Planning and Operations
Jean Williamson, Acting Secretary
Dave Perry, Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ)
Wendy Burns, Horizon BCBSNJ
Steven Wolinsky, M.D., Medical Director, Horizon BCBSNJ
Rosemary Middlebrook, Horizon BCBSNJ
Susan Rizzni, Horizon BCBSNJ
Louis Parrott, Medical Director, Magellan Health Services

Resolutions A (Closed Session) and B (Executive Session) – were read in their entirety.

Meeting No. 514, May 11, 2011: Chairwoman Culliton made a motion to accept the minutes. Commissioner Czech seconded the motion. Approved (5: 0: 0).

ISSUES

  1. Carrier Updates: None.

  2. Local Employers: David Pointer stated there are 21 new local employers and eight terminations.

  3. Performance Standards:  David Pointer gave a brief overview of the performance standards report memo which includes the ratings on the performance standards of each of the carriers.  The report is distributed annually.

  4. Ambulatory Surgery Centers (ASC) Payment Policy: The Division of Law was not ready to advise the Commission and the issue remained tabled.

  5. Surgery Centers Settlement Proposal-Single Room Facility:  Chairwoman Culliton made a motion to go into Executive Session under Resolution B. Commissioner Czech seconded the motion.  Approved (Vote 5: 0: 0). Upon returning from Executive Session, Chairwoman Culliton made a motion to permit the use of single-room surgery centers provided that they are either licensed by the NJ Department of Health and Senior Services or have Medicare accreditation.  Commissioner Burdge seconded the motion and all voted in favor.  Chairwoman Culliton made a motion was to approve a settlement proposal for single-room surgery centers provided that the settlement amount is less than the plan would have to otherwise pay under the prior or proposed payment policy, no members are balance billed, and the surgery centers at issue agree to go in-network. Commissioner Czech seconded the motion and all voted in favor.

  6. Bayonne Hospital: The Commission discussed this issue in Executive Session along with the previous issue since it is pending litigation. Upon returning from Executive Session, the Chairwoman Culliton stated for the record there was some discussion of the matter of litigation brought by Bayonne Hospital and the AG’s Office has been advised that the Commission is willing to have the issue of emergency room reimbursement come before it.

The following cases, due to HIPAA regulations, are heard in closed session.
Commissioner Czech made a motion to go into Closed Session under Resolution A.  Chairwoman Culliton seconded the motion. All voted in favor.

Case# SH071101 — (Member Present with Philip Yucht, LCSW) - This tabled Horizon NJ DIRECT15/Magellan appeal concerned the level of reimbursement for an out-of-network provider. Mr. Yucht, on behalf of the member, gave a short presentation. Commissioner Czech made a motion to deny this appeal because it is equitable for providers with greater credentials  to be reimbursed more than providers with lesser credentials. Chairwoman Culliton seconded the motion. Approved (Vote 3: 2: 0, Commissioner Burdge and Commissioner Nowlan voted nay.) 

Case# SH071102 — (Members Present)  This NJ DIRECT15 appeal concerned a denial of benefits for expenses for private duty nursing care, eight hours per day, five days per week for a dependent child. The Member’s parents presented an overview of their appeal and the reasons for private duty nursing. Horizon BCBSNJ representatives explained that medical necessity had not been established.  Chairwoman Culliton made a motion to deny this appeal because private duty nursing is not medically necessary. Commissioner Czech seconded the motion. Approved (Vote 4: 0: 1 Commissioner Burdge abstained)

Case #SH071103 — A settlement offer was before the Commission in a case involving denial of benefits for an injury deemed work related. The lien amount was $1,412.51 and the proposed settlement amount was $1,000.00. Chairwoman Culliton made a motion to accept this settlement as proposed. Commissioner Nowlan seconded the motion. All voted in favor.

Case #SH071104 — A settlement offer was before the Commission in a case involving denial of benefits for an injury deemed work related. The lien amount was $10,147.86. Chairwoman Culliton made a motion to authorize Socrates, Inc. to negotiate a resolution to this settlement proposal between the offered amount of $5,073.93 and $7,500.00. Commissioner Nowlan seconded the motion.  All voted in favor.

Case #SH071105 — A settlement offer was before the Commission in a case involving denial of benefits for an injury deemed work related. The lien amount was $56,127.41. Chairwoman Culliton made a motion to authorize Socrates, Inc. to negotiate a resolution to this settlement proposal to recover 70-80% of the lien which amounts to $39,000.00-$45,000.00. Commissioner Czech seconded the motion. All voted in favor.

Case #SH071106 — A settlement offer was before the Commission in a case involving denial of benefits for an injury deemed work related. The lien amount was $14,173.51. Chairwoman Culliton made a motion to authorize Socrates, Inc. to negotiate a resolution to this settlement proposal between the offered amount of $7,086.75 and $9,450.00. Commissioner Nowlan seconded the motion.  All voted in favor.

Case #SH071107 — A settlement offer was before the Commission in a case involving denial of benefits for an injury deemed work related. The lien amount was $46,957.21. Chairwoman Culliton made a motion to authorize Socrates, Inc. to demand and accept 50% of the lien as full reimbursement which amounts to $23,478.61. Commissioner Czech seconded the motion. All voted in favor.

Case #SH071108 — A settlement offer was before the Commission in a case involving denial of benefits for an injury deemed work related. The lien amount was $10,586.37 and the proposed settlement amount was $8,000.00. Chairwoman Culliton made a motion to accept this settlement as proposed.  Commissioner Nowlan seconded the motion. All voted in favor.

There being no further appeals, a motion was made to return to open session by Chairwoman Culliton and was seconded by Commissioner Czech. All voted in favor. Chairwoman Culliton made a motion to adjourn. It was seconded by Commissioner Burdge and all voted in favor.
The State Health Benefits Commission meeting was adjourned at 3:15 PM.

Respectfully submitted,


Jean M. Williamson, CEBS
Acting Secretary
State Health Benefits Commission

 

 

 

 


Meeting No. 516
Minutes
August 10, 2011, 10:00 AM
State Health Benefits Commission

Adequate notice of this meeting has been provided through the annual notice of the schedule of regular meetings of the Commission filed with and prominently posted in the offices of the Secretary of State. The 2011 annual meeting schedule was mailed to the Secretary of State, Star Ledger and the Trenton Times on December 10, 2010 and revised notice was sent on July 11, 2011.

The meeting of the State Health Benefits Commission of New Jersey was called to order on Wednesday, August 10, 2011 at 10:18 AM. The meeting was held at the Division of Pensions and Benefits, 50 West State Street, 1st floor Conference Room, Trenton, New Jersey, and was attended by the following members of the Commission and Division staff:

ROLL CALL

Susanne Culliton, Chairperson, representing State Treasurer Andrew P. Sidamon-Eristoff
Sylvia Allen-Ware, representing Commissioner Thomas B. Considine, Department of Banking & Insurance
Robert M Czech, Chair, Civil Service Commission
Patrick Nowlan, Representative for State Government Employees
Dudley Burdge, Representative for Local Government Employees

ALSO PRESENT: 

Rubin Weiner, Deputy Attorney General
David Pointer, Manager, Policy, Planning and Operations
Jean Williamson, Acting Secretary
Barbara Scherer, State Health Benefits Program
Dave Perry, Horizon Blue Cross Blue Shield New Jersey
Wendy Burns, Horizon Blue Cross Blue Shield New Jersey
Rosemary Middlebrook, Horizon Blue Cross Blue Shield New Jersey
Katherine Impellizzeri, Aetna Health Plan
Dr. Thomas Howe, Medical Director, Aetna Health Plan

Resolutions A (Closed Session) and B (Executive Session) – were read in their entirety.

Meeting No. 515, July 13, 2011: Commissioner Czech made a motion to accept the minutes. Chairwoman Culliton seconded the motion.  All voted in favor.  

 ISSUES 

  1. Carrier Updates: David Pointer announced St. Joseph Hospital in Patterson, NJ and Centra State Medical Center in Freehold, NJ are scheduled to terminate from the Horizon network effective January 1, 2012, although negotiations are continuing.
      
  2. Ambulatory Surgery Centers Payment Policy: Horizon provided a handout to the Commission which explained the proposed policy. There was also discussion concerning the licensing/certification of single room surgery centers.  Dave Perry of Horizon said from a quality perspective Horizon requires all participating ASCs (multi-room or single room) to be Medicare certified, which in itself is a rigorous and stringent certification process. In addition to Medicare certification, they require AAAHC (Accreditation Association for Ambulatory Health Care) or now AAAASF (American Association for Accreditation of Ambulatory Surgical Facilities).  Both of these accrediting organizations’ missions is to develop and implement the highest quality of patient care by developing standards that measure and evaluate quality performance and patient safety in an ASC setting. Chairwoman Culliton made a motion to go into Executive Session under Resolution B. Commissioner Nowlan seconded the motion. Motion passed. (Vote 5: 0: 0).  Upon returning from Executive Session Commissioner Burdge requested an explanation of PHCS charges. Mr. Perry explained charges are not market based. The PHCS R&C for ASCs is actually the R&C for outpatient hospital services. Ninety percent of the charges in PHCS database used to develop an ASC R&C allowance are actually from outpatient hospital claims data.  Under the payment policy, Horizon would pay 160% of CMS. Chairwoman Culliton made a motion to adopt Horizon’s proposed Ambulatory Surgery Center payment policy.  Commissioner Czech seconded the motion. Motion passed. (Vote 4: 0: 1, Commissioner Nowlan abstained).    

The following cases, due to HIPAA regulations, are heard in closed session.

Chairwoman Culliton made a motion to go into Closed Session under Resolution A.  Commissioner Nowlan seconded the motion.  All voted in favor.

Case# SH081101This Division appeal concerned a denial for retired group health benefit coverage for the member.  Commissioner Nowlan made a motion to deny this appeal. Commissioner Burdge seconded the motion.  Approved (Vote 4:1, Chairperson Culliton abstained).

Case# SH081102 — This Horizon NJ DIRECT15 appeal challenged the different level of reimbursement between Upper Perk Physical Therapy, an in-network provider, and Novacare Outpatient Rehabilitation, an in-network facility.  Wendy Burns of Horizon BCBSNJ explained that claims for physical therapy provided by NovaCare reflect that the services were billed by the facility, an outpatient setting which does not require a copayment.  Claims submitted by Upper Perk reflect that physical therapy services were provided in an office setting by a provider and, as such, the member is subject to a $15 copayment per visit. Chairwoman Culliton made a motion to deny this appeal. Commissioner Czech seconded the motion. Approved (Vote 5: 0: 0)  

Case #SH081103 (Member Present) - This Aetna appeal concerned the denial of services by an out-of-network provider with no prior authorization. Member presented an overview of his appeal.  Aetna Representatives explained there are no benefits allowable for out-of-network services unless emergent or urgent as defined by the plan. The procedure that was performed can be considered cosmetic and requires precertification from Aetna to approve for medical necessity. Commissioner Czech made a motion to deny this appeal because the provider was an out-of-network provider and the services were not pre-certified as required. Commissioner Nowlan seconded the motion. Approved (Vote 4: 1: 0, Chairperson Culliton voted nay).

Case #SH081104 – Commissioner Allen-Ware recused herself from this appeal.  Final Administrative Determination (FAD) – Chairperson Cullitonmade a motion to accept the FAD draft concerning the denial of additional reimbursement for an out-of-network provider.Commissioner Czech seconded the motion.Motion failed. (Vote 2: 2: 0, Commissioner Burdge and Nowlan voted nay). The FAD was tabled.    

Case #SH071105 - Chairperson Culliton made a motion to affirm the decision of the Office of Administrative Law (OAL) which upheld the Commission’s denial of benefits for Viagra beyond the four pill limit. Commissioner Czech seconded the motion. Approved (Vote 5: 0: 0).

David Pointer advised the Commission that the SHBP Plan Design Committee has been meeting and discussing changes to plan designs. The Committee will be voting on the Employee Group Waiver Plan (EGWP) most likely at their August 17th meeting. The Commission would also need to approve the EGWP before it could be implemented, therefore a Special Commission meeting will need to be scheduled. The meeting can be scheduled as a teleconference. Availability of the Commission members was requested. A brief discussion took place between the Commissioners and the division staff of their availability.

Jean Williamson advised the Commission that the September 14, 2011 meeting is being rescheduled, a date and location has not yet been determined. Ms. Williamson will advise the Commission when it has been established. 

There being no further appeals or business, a motion was made to return to open session and to adjourn by Chairperson Culliton and seconded by Commissioner Czech.All voted in favor.
The State Health Benefits Commission meeting was adjourned at 11:41 AM.

Respectfully submitted,


Jean M. Williamson, CEBS
Acting Secretary
State Health Benefits Commission

 

 

 

 


Meeting No. 517
Minutes
September 22, 2011, 10:00 AM
 State Health Benefits Commission

Adequate notice of this meeting has been provided through the annual notice of the schedule of regular meetings of the Commission filed with and prominently posted in the offices of the Secretary of State. The 2011 annual meeting schedule was mailed to the Secretary of State, Star Ledger and the Trenton Times on December 10, 2010 and revised notice was sent on September 15, 2011. The meeting of the State Health Benefits Commission of New Jersey was called to order on Thursday, September 22, 2011 at 10:14 AM. The meeting was held at the Division of Pensions and Benefits, 50 West State Street, 1st floor Conference Room, Trenton, New Jersey, and was attended by the following members of the Commission and Division staff:

ROLL CALL

Susanne Culliton, Chairperson, representing State Treasurer Andrew P. Sidamon-Eristoff
Ken Kobylowski, Chief of Staff, Department of Banking and Insurance
Robert M Czech, Chair, Civil Service Commission
Patrick Nowlan, Representative for State Government Employees
Dudley Burdge, Representative for Local Government Employees

ALSO PRESENT: 

Thomas B Considine, Commissioner, Department of Banking and Insurance (via telephone)
Rubin Weiner, Deputy Attorney General
Diane Weeden, Deputy Attorney General
Florence J Sheppard, Acting Director Division of Pensions and Benefits
David Pointer, Manager, Policy, Planning and Operations
Jean Williamson, Acting Secretary
Barbara Scherer, State Health Benefits Program

Resolutions A (Closed Session) and B (Executive Session) – were read in their entirety.

ISSUES

  1.   Settlement of Bayonne Hospital Litigation: Commissioner Kobylowski made a motion to go onto Executive Session under Resolution B. Chairperson Culliton seconded the motion. Commissioner Burdge strongly stated his disagreement with not discussing the matter in open session.  He said “An issue of such magnitude should be discussed in Public Session and not in Executive Session”; Commissioner Nowlan agreed. Motion passed. (Vote 3: 2: 0, Commissioner Burdge and Nowlan voted nay). Upon return from Executive Session, Chairperson Culliton made a motion to approve payment of $5,980,000 for the SHBP/SEHBP share of the Horizon settlement with Bayonne Medical Center pursuant to the terms outlined in the confidential settlement agreement and  proposed amendment thereto as discussed in Executive Session and in consideration for dismissal of the five appeals filed by Bayonne Medical Center against the State Health Benefits Commission  in the Appellate Division of the Superior Court, docket numbers A-5063-10T4, A-5064-10T4, A-5065-10T4, A-5067-10T4 and A-5068-10T4, and other consideration as discussed during Executive Session.  This approval is contingent on the execution by Horizon Blue Cross Blue Shield of New Jersey and IJKG, LLC, IJKG PROPCO LLC, and IJKG OPCO LLC, d/b/a/ Bayonne Medical Center, of the Amendment to the Confidential Settlement Agreement approved by the Attorney General and no funds shall be released until such time as the amendment is executed. This approval is also conditioned on the $5,980,000 being properly allocated between SHBP and SEHBP claims. Commissioner Czech seconded the motion. All voted in favor.

Minutes of Meeting No. 516, August 10, 2011:Chairperson Culliton made a motion to accept the minutes. Commissioner Czech seconded the motion.  Motion passed. (Vote 4: 0: 1, Commissioner Kobylowski abstained)
 
Case #SH091101 —  Final Administrative Determination (FAD) – Chairperson Cullitonmade a motion to accept the FAD draft concerning the denial of additional reimbursement for an out-of-network provider.Commissioner Kobylowski seconded the motion.Motion passed. (Vote 3: 2: 0, Commissioner Burdge and Nowlan voted nay). 

There being no further business, a motion was made to adjourn by Commissioner Czech and seconded by Commissioner Kobylowski.All voted in favor.  The State Health Benefits Commission meeting was adjourned at 10:49 AM.                    

Respectfully submitted,


Jean M. Williamson, CEBS
Acting Secretary
State Health Benefits Commission

 

 

 

 


Meeting No. 518
Minutes
October 12, 2011, 10:00 AM
State Health Benefits Commission

Adequate notice of this meeting has been provided through the annual notice of the schedule of regular meetings of the Commission filed with and prominently posted in the offices of the Secretary of State.  The 2011 annual meeting schedule was mailed to the Secretary of State, Star Ledger and the Trenton Times on December 10, 2010 and revised notice was sent on September 15, 2011.

The meeting of the State Health Benefits Commission of New Jersey was called to order on Wednesday, October 12, 2011 at 10:10 AM.  The meeting was held at the Division of Pensions and Benefits, 1st Floor Board Room, 50 West State Street, Trenton, New Jersey, and was attended by the following members of the Commission and Division staff:

ROLL CALL

Susanne Culliton, Chairperson, representing State Treasurer Andrew P. Sidamon-Eristoff
Kenneth Kobylowski, representing Commissioner Thomas B. Considine, Department of Banking & Insurance
Robert M Czech, Chair, Civil Service Commission
Patrick Nowlan, Representative for State Government Employees
Dudley Burdge, Representative for Local Government Employees

ALSO PRESENT : 

Eileen S. Den Bleyker, Senior Deputy Attorney General
Diane Weeden, Deputy Attorney General
Florence J. Sheppard, Acting Director, Division of Pensions and Benefits
David Pointer, Manager, Policy, Planning and Operations
Jean Williamson, Acting Secretary
Barb Scherer, State Health Benefits Program
Angela Pearson, Medco Health Solutions
Edward Fox, Aon-Hewitt Consultants
Susan Marsh, Aon-Hewitt Consultants
James Christ, Aon-Hewitt Consultants

Resolutions A (Closed Session) and B (Executive Session) – were read in their entirety.

Meeting No. 517, September 22, 2011:Chairwoman Culliton made a motion to accept the minutes. Commissioner Nowlan seconded the motion and all voted in favor.

ISSUES

  1. Chairwoman Culliton made a motion to accept the Plan Design Committee Plan Changes and to authorize the Division to make any necessary changes to the contracts.  Commissioner Czech seconded the motion.  All voted in favor.

  2. Edward Fox, Aon-Hewitt Consulting, gave an overview of the 2012 proposed rates. Susan Marsh, Aon-Hewitt Consulting, reviewed the 2012 Rate Renewal Recommendations for Medical/Rx for the Active Employees and Retirees of the State Group, Active Employees and Retirees of the Local Government Group and the Dental Plans of the State Health Benefits Program (SHBP). Also present from Aon-Hewitt Consulting was James Christ.

The following is a summary from Aon-Hewitt Consulting:

Recommended Plan Year 2012
Medical/Rx Rate Renewal Recommendation
for Active Employees and Retirees
of the State Group


  • For Plan Year 2012, Aon Hewitt is recommending premium rate changes that – in the aggregate – represent an overall increase of 7.1% for State Active Employees and Retirees:
 
Employees
Early
Retirees
Medicare
Retirees
NJ DIRECT1O
8.4%
3.0% 
0.0%
NJ DIRECT15
8.4%
3.0% 
0.0%
Aetna HMO
8.4%
3.0% 
0.0%
Cigna HMO    
10.0%
3.0% 
0.0%
Rx Card Plan
11.1%
NA
NA
       
Average Change
9.0%
3.0% 
0.0%
  • This recommended rate renewal assumes:

    —The Retiree Rx copays and Out-Of-Pocket Maximum for NJ DIRECT and HMOs will be frozen at the Plan Year 2011 levels, except that the Mail Generic copays will be reduced to $5;

—The SHBP will migrate, effective 1/1/12, from the current RDS Medicare Rx integration approach to an Employer Group Waiver Program (known as EGWP Plus Wrap), which Aon Hewitt projects will result in Plan Year Retiree Rx savings of  $22 million;

—New benefit options, as required by Chapter 78 and as summarized in Exhibit 7 of the renewal report (Pages 52-53), will be effective 1/1/12, but will likely have limited enrollment during Plan Year 2012;

—Any remaining legacy enrollment in NJ PLUS will have migrated to NJ DIRECT by 1/1/12;

—The revised Employee contribution schedule that went into effect on July 1, 2011 will have little impact on Employee enrollment for the first year, since the current 1.5% of salary floor will exceed contributions generated by the new schedule for all Employees in the first year of the new schedule.  However, many Employees will have increased contributions in the second year of the new schedule (which begins July 1, 2012), so the renewal projections assume that Plan Year 2012 will have 1,500 more new Retirees than in prior years, due to Employees with 25 or more years of service retiring in response to increased Employee contributions;

—No other changes in Employee or Retiree benefits, other than those mandated by New Jersey or federal law, as outlined in the renewal report.  Specific to Federal Health Care Reform, the SHBP will be impacted by:

  • Coverage of Dependent Children to Age 26 (which increases costs $9 million)
  • Elimination of Benefit Maximums (which increases costs $7 million)
  • Early Retiree Reinsurance Program (which reduces Early Retiree claim costs by $25 million)

The renewal report summarizes a number of benefit plan design changes, each of which could further reduce plan costs.

—State Employee enrollment will decrease about by about 3,000 in Plan Year 2012, and

—State Early Retiree enrollment will increase by about 1,200 in Plan Year 2012, while Medicare Retiree enrollment will increase by about 1,800.

  • Aggregate differences in the rate changes for different benefit plans and coverage tiers, and between Actives and Retirees, reflect the impact of:

—Medicare Retiree medical trends have been below industry norms for the past few years and we are projecting that the low trend levels will continue into Plan Years 2011 and 2012.

—While HMO claim trends had averaged about 3% higher than Horizon trends for a number of years, they appear to be moderating and we are therefore projecting that HMOs will trend at the same rate as the Horizon plans in Plan Year 2012.

—Projected Retiree costs have been reduced due to projected savings from the change to EGWP+Wrap and from the Early Retiree Reinsurance Program.

—For Active premiums, increases vary by coverage tier, since the differences in costs by coverage tier have been revised based on actual SHBP experience.

  • Factors contributing to the recommended rate actions include:

—8.6% average trend increase from Plan Year 2011 to Plan Year 2012, which is lower than industry trends, and

—Higher trends for Early Retirees, which are more than offset by the Early Retiree Reinsurance credit, and

—EGWP+Wrap savings which reduce Medicare Retiree projected costs.

  • Plan Year 2012 projected costs for the State Group are $1.92 billion ($1.46 billion for Actives and $.46 billion for Retirees).  Plan Year 2012 renewal premiums are set to match the projected $1.92 billion costs, so there is no loss or gain projected for Plan Year 2012.

Recommended Plan Year 2012
Medical/Rx Rate Renewal Recommendation
for Active Employees and Retirees
of the Local Government Group


  • For Plan Year 2012, Aon Hewitt is recommending premium rate changes that – in the aggregate – represent an overall increase of 9.5% for Local Government Active Employees and Retirees:
 
Employees
Early
Retirees
Medicare
Retirees
NJ DIRECT1O
10.0%
10.5% 
2.0%
NJ DIRECT15
10.0%
10.5% 
2.0%
Aetna HMO
10.0%
10.5%
2.0%
Cigna HMO    
10.0%
10.5%
2.0%
Rx Card Plan
12.5%
NA
NA
       
Average Change
10.3%
10.5% 
2.0%
  • This recommended rate renewal assumes:

—The Retiree Rx copays and Out-Of-Pocket Maximum for NJ DIRECT and HMOs will be frozen at the Plan Year 2011 levels, except that the Mail Generic copays will be reduced to $5;

—New benefit options, as required by Chapter 78 and as summarized in Exhibit 7 of the renewal report (Pages 53-54), will be effective 1/1/12, but will likely have limited enrollment during Plan Year 2012;

—The SHBP will migrate, effective 1/1/12, from the current RDS Medicare Rx integration approach to an Employer Group Waiver Program (known as EGWP Plus Wrap), which Aon Hewitt projects will result in Plan Year 2012 Retiree Rx savings of $12 million;

—The revised Employee contribution schedule that went into effect on July 1, 2011 will have little impact on Employee enrollment for the first year, since the current 1.5% of salary floor will exceed contributions generated by the new schedule for all Employees in the first year of the new schedule.  In the second year (which begins July 1, 2012), many Employees will have increased contributions and the renewal projections assume that a small number of employees will drop coverage, which is more than offset by new employers joining the SHBP.  The renewals assume that these changes will apply equally to certain future Retirees, so the renewal projections assume that there is no significant change to the number of new Retirees in Plan Year 2012 compared to prior years.

—No other changes in Employee or Retiree benefits, other than those mandated by New Jersey or federal law, as outlined in the Renewal Report.  Specific to Health Care Reform, the SHBP will be impacted by:

  • Coverage of Dependent Children to Age 26 (which increases costs $10 million)
  • Elimination of Benefit Maximums (which increases costs $4 million)
  • Early Retiree Reinsurance Program (which reduces Early Retiree claim costs by $16 million)

The renewal report summarizes a number of benefit plan design changes, each of which could further reduce plan costs.

—Active Employee enrollment will increase by 1,300 in Plan Year 2012, and

—Early Retiree enrollment will increase by 800 in Plan Year 2012, while Medicare Retiree enrollment will also increase by 800.

  • Aggregate differences in the rate changes for different benefit plans and coverage tiers, and between Actives and Retirees, reflect the impact of:

—Medicare Retiree medical trends have been below industry norms for the past few years and we are projecting that the low trend levels will continue into Plan Years 2011 and 2012.

—While HMO claim trends have averaged about 3% higher than Horizon trends for a number of years, they appear to be moderating and we are therefore projecting that HMOs will trend at the same rate as the Horizon plans in Plan Year 2012.

—Projected Retiree costs have been reduced due to projected savings from the change to EGWP+Wrap and from the Early Retiree Reinsurance Program.

—For Active premiums, increases vary by coverage tier, since the differences in costs by coverage tier have been revised based on actual SHBP experience.

  • Factors contributing to the recommended rate actions include:

—9.2% average trend increase from Plan Year 2011 to Plan Year 2012, which is below industry norms;

—Higher trends for Early Retirees, which are partially offset by the Early Retiree Reinsurance credit,

—EGWP+Wrap savings which reduce Medicare Retiree projected costs, and

—1.3% margin added to the renewal rates, because the Claim Stabilization Reserve is below the recommended level of 2 months of Plan costs.

  • Plan Year 2012 projected costs for the Local Government Group are $1,030 million ($732 million for Actives and $298 million for Retirees).  Plan Year 2012 renewal premiums are set to generate a gain of $12 million, which will be added to the Claim Stabilization Reserve to offset losses from Plan Year 2011 and bring the Claim Stabilization Reserve closer to the recommended level of 2.0 months of Plan costs.

Recommended Dental Plans Rate Renewal
for Plan Year 2012


  • For the SHBP Dental Plans (Employee and Retiree Dental Expense Plans and Employee DPOs) for Plan Year 2012, Aon Hewitt recommends the following premium rate adjustments, which – in the aggregate – represent a 5.6% overall decrease in program costs:
Dental Expense Plans
 
Actives -10.0%  
Retirees -3.0%  
     
The overall decrease for the Dental Expense Plans is 6.4%

Dental Plan Organizations (DPOs)
 
Aetna  2.9%  
Benecare  2.0%  
Cigna 3.0%  
Community  0.0%  
Healthplex -5.0%  
Horizon  3.0%  
     
The overall increase for the DPOs is 2.1%.

  • For the Dental Expense Plans, this favorable rate action reflects a continuation of favorable SHBP Dental Expense Plan trends, which have averaged about 5% lower than industry norms since Plan Year 2003.
  • 4 of the DPOs currently have a Value Ratio greater than 1.00, and the others have Value Ratios just below 1.00 which will increase to greater than 1.00 by the end of Plan Year 2012 if they receive no rate increase.  For this reason, we are recommending a premium increase for those DPOs who requested increases.  The DPOs requested rate increases ranging from a low of -5.0% to a high of +5.7%.
  • For the DPOs that requested an increase, Aon Hewitt is recommending that the increase be capped at the lesser of the average DPO renewal request of 3.0% and the amount that would bring their Value Ratio to 1.00.
  • This recommended rate renewal assumes no changes in benefits for Retirees and no changes in DPO vendors.  For Actives, the Employee Dental Expense Plan will change from a passive PPO to an active/true PPO for Plan Year 2012, with lower coinsurance for Out-of-Network dental care.  This will encourage use of In-Network dental providers and is projected to reduce Employee Dental Expense Plan costs 10% in Plan Year 2012.
  • Aon Hewitt is projecting total Claim Stabilization Reserves of $9 million for Retirees at the end of Plan Year 2012, assuming that the Plan is fully funded.
  • Aon Hewitt is projecting that Employee Dental Expense enrollment will decrease 3% between Plan Years 2011 and 2012.  As a result, Plan Year 2012 projected Active Employee enrollment is:  60,900 Employees enrolled in the Dental Expense Plan and 36,700 Employees enrolled in the DPO plans.  Retiree Dental Expense Plan enrollment is expected to again increase 10%, to 71,300 for Plan Year 2012.
  • Plan Year 2012 projected costs for the SHBP Dental Plans are $120.6 million, with $53.4 million attributable to the Employee Dental Expense Plan, $48.6 million attributable to the Retiree Dental Expense Plan, and $18.6 million attributable to the DPOs.

Aon-Hewitt Consulting responded to questions concerning the recommendations for the 2012 Rate Renewals that were presented by the commissioners prior to the meeting.  Angela Pearson, from Medco Health Solutions, responded to several questions concerning the EGWP Plus Wrap program.

Commissioner Nowlan questioned the 10% rate load being recommended by Aon Hewitt for coverage for part-time employees who may enroll in NJ DIRECT15 and the Employee Prescription Drug Card Plan.  Commissioner Nowlan made a motion not to implement the 10% rate load for part-time employees to make coverage more affordable.  Commissioner Burdge seconded the motion. Failed (2: 3: 0, Chairperson Culliton, Commissioner Czech and Kobylowski voted nay). 

Commissioner Czech made a motion to accept the State, Local Employer and Dental 2012 rate renewals as presented.  Commissioner Burdge seconded the motion and all voted in favor.

David Pointer announced that Open Enrollment will be extended to November 11, 2011.

Case #SH101101 - A settlement offer was before the Commission in a case involving denial of benefits for an injury deemed work related. The lien amount was $16,609.42 and the proposed settlement amount was $7,000.00.  Chairwoman Culliton made a motion to approve this settlement proposal, Commissioner Kobylowski seconded the motion. All voted in favor.

There being no further business, a motion was made to adjourn by Chairperson Culliton and seconded by Commissioner Burdge.All voted in favor. The State Health Benefits Commission meeting was adjourned at 12:24 PM.

Respectfully submitted,


Jean M. Williamson, CEBS
Acting Secretary
State Health Benefits Commission

 

 

 



Meeting No. 519
Minutes
November 9, 2011, 10:00 AM
State Health Benefits Commission

Adequate notice of this meeting has been provided through the annual notice of the schedule of regular meetings of the Commission filed with and prominently posted in the offices of the Secretary of State.  The 2011 annual meeting schedule was mailed to the Secretary of State, Star Ledger and the Trenton Times on December 10, 2010 and revised notice was sent on September 15, 2011.

The meeting of the State Health Benefits Commission of New Jersey was called to order on Wednesday, November 9, 2011 at 10:15 AM. The meeting was held at the Division of Pensions and Benefits, 50 West State Street, 1st floor Conference Room, Trenton, New Jersey, and was attended by the following members of the Commission and Division staff:

ROLL CALL

Susanne Culliton, Chairperson, representing State Treasurer Andrew P. Sidamon-Eristoff
Sylvia Allen-Ware, representing Commissioner Thomas B. Considine, Department of Banking & Insurance
Robert M Czech, Chair, Civil Service Commission
Patrick Nowlan, Representative for State Government Employees – Via telephone. Left meeting at 11:32 AM
Dudley Burdge, Representative for Local Government Employees

ALSO PRESENT: 

Diane Weeden, Deputy Attorney General
Kellie Pushko, Deputy Attorney General
David Pointer, Manager, Policy, Planning and Operations
Jean Williamson, Acting Secretary
Barbara Scherer, State Health Benefits Program
Cheryl Eagan, Horizon Blue Cross Blue Shield New Jersey
Wendy Burns, Horizon Blue Cross Blue Shield New Jersey
Rosemary Middlebrook, Horizon Blue Cross Blue Shield New Jersey
Dr. Claudia Hanson, Medical Director Horizon Blue Cross Blue Shield New Jersey
Katherine Impellizzeri, Aetna Health Plan
Dr. George Vermeire, Medical Director Aetna Health Plan

Resolutions A (Closed Session) and B (Executive Session) – were read in their entirety.

Meeting Minutes No. 518, October 12, 2011:Jean Williamson advised the Commission a correction was needed on page 8, Case SH101101.  It stated that Commissioner Kelleher seconded the motion; it should have said Commissioner Kobylowski seconded the motion. The minutes will be corrected to reflect the change.  Chairperson Culliton made a motion to accept the corrected minutes.  Commissioner Czech seconded the motion.  All voted in favor.  

ISSUES

  1. Carrier Updates:  David Pointer said there were no updates.  Commissioner Burdge asked if the network of dentists on Aetna’s website was correct or if it would change due to the Employee Dental Expense Plan becoming a true Preferred Provider Organization (PPO).   Mr. Pointer assured the Commission that Aetna’s provider directory is accurate and no significant changes to the network are anticipated.

  2. Local Employers:   Mr. Pointer said the 2011 year-to-date Report for New Local Government Employers and Termination of Local Government Employers was in the Commission books for their information.  

  3. 2011 Meeting Schedule – For Approval  –  Jean Williamson advised the Commission that meetings were scheduled for the second Wednesday of every month as usual for calendar year 2012. These dates were subject to change as the Civil Service Commission’s 2012 schedule had not been finalized.   Commissioner Burdge made a motion to approve the 2012 meeting dates.  Commissioner Nowlan seconded the motion. All voted in favor. 

  4. Update on Part-time eligibility for new plans: Mr. Pointer advised the Commission that currently part-time employees are limited to both NJ DIRECT15 and the Employee Prescription Drug Plan, or NJ DIRECT15 only, provided they pay the full cost of coverage for the level of coverage selected.  Chapter 78 permits Part-time employees to enroll in any of the medical plans offered in the 2012 Open Enrollment and the Employee Prescription Drug Plan or the medical plan alone.  Employers were advised of this change in the Open Enrollment information sent to all employers.  Commissioner Nowlan thanked everyone involved for pursuing the matter.  

The following cases, due to HIPAA regulations, are heard in closed session.

Commissioner Burdge made a motion to go into Closed Session under Resolution A.  Commissioner Czech seconded the motion.  All voted in favor.

Case# SH111101 (Member Present) - This Horizon NJ DIRECT15 appeal concerned the denial of benefits for chartered air transportation for the member’s husband, now deceased. The Member presented an overview of her appeal.  Following a short discussion, it was discovered that two letters were missing from the Commissioner’s binders.  A letter from the member’s daughter dated August 4, 2001 and a letter dated July 1, 2001 from the patient’s Oncologist at Hahnemann University Hospital.  Copies of the letters were distributed to the Commission. Horizon BCBSNJ representatives explained that Air Ambulance transportation to the nearest facility is considered when other emergent transportation poses a threat to the patient. The documentation reviewed did not meet the criteria for this patient to be transported by air from Canada to the United States.  Commissioner Czech made a motion to deny this appeal since the criteria to warrant air ambulance could not be established and air transportation is not a covered benefit under the plan.  Chairperson Culliton seconded the motion.  Approved. (Vote 4: 0: 1, Commissioner Burdge voted nay).

Case #SH111102 – This Horizon NJ DIRECT15 appeal concerned the denial of reimbursement for Embryo transfers.  Chairperson Culliton made a motion to deny this appeal and to transmit this appeal to be consolidated with the pending appeal in the Office of Administrative Law (OAL).  Commissioner Czech seconded the motion.  Approved. (Vote 3: 0: 1, Commissioner Burdge abstained; Commission Nowlan had left the meeting).

Case #SH111103 (Member Present via telephone) This Aetna appeal concerned the pre-service denial of a X-Stop procedure which was deemed experimental/investigational.   The Member provided an overview of his appeal.  A discussion took place concerning if the procedure is covered by CMS or any of the other health carriers.  It was established that CMS covers the procedure under limited conditions and Horizon BCBSNJ does not cover the procedure.  Dr. George Vermeire, Medical Director at Aetna Health Plan said a review of the Clinical Policy Bulletin for the X-Stop procedure was done July 2011 and there is not enough clinical evidence to support that this procedure is effective.  The next review of the policy is schedule for January 13, 2012.   Chairwoman Culliton made a motion to deny this appeal in accordance with Aetna’s Clinical Policy Bulletin which has deemed this procedure as investigational/experimental and thereby not covered by the plan.  However, she requested that when reviewing the Clinical Policy Bulletin on January 13, 2012 that Aetna consider Medicare’s position regarding this procedure.  Dr. Vermeire ensured the Commission the information would be included.  Commissioner Czech seconded the motion.  Approved. (Vote 4: 0: 0) 

Case #SH111104 - The Member had requested that the denial of State Health Benefit Coverage be forwarded to the Office of Administrative Law (OAL) for a hearing.  Chairwoman Culliton made a motion to deny this request for a hearing at the OAL and to issue a Final Administrative Determination (FAD).  Commissioner Czech seconded the motion. All voted in favor.

Case #SH111105 - Chairperson Culliton made a motion to accept the decision of the Office of Administrative Law (OAL) and to note the member’s exceptions.  Commissioner Czech seconded the motion.  All voted in favor.

Case #SH111106 – A settlement offer was before the Commission in a case involving denial of benefits for an injury deemed work related. The lien amount was $30,573.60 and the proposed settlement amount was $12,500.00. Chairwoman Culliton made a motion to authorize Socrates, a Horizon recovery subcontractor, to negotiate a resolution that calls for recovery between $12,500.00 and $15,287.00.  Commissioner Burdge seconded the motion.  All voted in favor.

Case #SH111107 – A settlement offer was before the Commission in a case involving denial of benefits for an injury deemed work related. The lien amount was $20,315.10 and the proposed settlement amount was $7,500.00.  Chairperson Culliton made a motion to accept the settlement amount of $7,500.00.  Commissioner Burdge seconded the motion.  All voted in favor.

Case #SH111108 – A settlement offer was before the Commission in a case involving denial of benefits for an injury deemed work related. The lien amount was $61,925.11 and the proposed settlement amount was $35,000.00.  Chairwoman Culliton made a motion to authorize Socrates, a Horizon recovery subcontractor, to negotiate a resolution that calls for recovery between 75% - 100% of the lien which amounts to $46,443.83 - $61,925.11. Commissioner Burdge seconded the motion.  All voted in favor.

Case #SH111109 – A settlement offer was before the Commission in a case involving denial of benefits for an injury deemed work related.  The lien amount was $7,183.92 and the proposed settlement amount was $3,591.96.  Chairwoman Culliton made a motion to authorize Socrates, a Horizon recovery subcontractor, to negotiate a resolution that calls for recovery between $3,591.96 and $4,500.00.  Commissioner Burdge seconded the motion. All voted in favor.

Case #SH111110 – A settlement offer was before the Commission in a case involving denial of benefits for an injury deemed work related. The lien amount was $6,051.88 and the proposed settlement amount was $3,000.00.  Chairperson Culliton made a motion to accept the settlement amount of $3,000.00.  Commissioner Burdge seconded the motion.  All voted in favor.

Case #SH111111 – A settlement offer was before the Commission in a case involving denial of benefits for an injury deemed work related.  The lien amount was $4,347.95 and the proposed settlement amount was $2,000.00.  Chairwoman Culliton made a motion to authorize Socrates, a Horizon recovery subcontractor, to negotiate a resolution that calls for recovery between $2,000.00 and $3,000.00.  Commissioner Burdge seconded the motion.  All voted in favor.

Case #SH111112 – A settlement offer was before the Commission in a case involving denial of benefits for an injury deemed work related. The lien amount was $6,562.46 and the proposed settlement amount was $3,000.00.  Chairperson Culliton made a motion to accept the settlement amount of $3,000.00.  Commissioner Burdge seconded the motion.  All voted in favor.

Case #SH111113 – A settlement offer was before the Commission in a case involving denial of benefits for an injury deemed work related. The lien amount was $33,916.38 and the proposed settlement amount was $2,000.00.  Chairwoman Culliton made a motion to authorize Socrates, a Horizon recovery subcontractor, to negotiate a resolution that calls for recovery between $2,000.00 and $3,750.00.  Commissioner Czech seconded the motion. All voted in favor.

Case #SH111114 – A settlement offer was before the Commission in a case involving denial of benefits for an injury deemed work related. The lien amount was $3,388.78 and the proposed settlement amount was $2,541.58.  Chairperson Culliton made a motion to accept the settlement amount of $2,541.58 which represented 75% of the lien amount. Commissioner Burdge seconded the motion.  All voted in favor.

Case #SH111115 – A settlement offer was before the Commission in a case involving denial of benefits for an injury deemed work related. The lien amount was $11,924.17 and the proposed settlement amount was $5,962.08.  Chairwoman Culliton made a motion to accept the settlement amount of $5,962.08.  Commissioner Czech seconded the motion.  All voted in favor.

Case #SH111116 – A settlement offer was before the Commission in a case involving denial of benefits for an injury deemed work related. The lien amount was $2,428.89 and the proposed settlement amount was $2,000.00.  Chairperson Culliton made a motion to accept the settlement amount of $2,000.00 which represents 82.5% of the lien amount. Commissioner Burdge seconded the motion.  All voted in favor.

There being no further appeals or business, a motion was made to return to open session and to adjourn by Chairperson Culliton and seconded by Commissioner Burdge.All voted in favor.
The State Health Benefits Commission meeting was adjourned at 12:24 PM.

Respectfully submitted,


Jean M. Williamson, CEBS
Acting Secretary
State Health Benefits Commission

 

 


 


Meeting No. 520
Minutes
December 14, 2011, 10:00 AM
State Health Benefits Commission

Adequate notice of this meeting has been provided through the annual notice of the schedule of regular meetings of the Commission filed with and prominently posted in the offices of the Secretary of State.  The 2011 annual meeting schedule was mailed to the Secretary of State, Star Ledger and the Trenton Times on December 10, 2010 and revised notice was sent on September 15, 2011.

The meeting of the State Health Benefits Commission of New Jersey was called to order on Wednesday, December 14, 2011 at 10:11 AM.  The meeting was held at the Division of Pensions and Benefits, 50 West State Street, 1st floor Conference Room, Trenton, New Jersey, and was attended by the following members of the Commission and Division staff:

ROLL CALL

Susanne Culliton, Chairperson, representing State Treasurer Andrew P. Sidamon-Eristoff
Sylvia Allen-Ware, representing Commissioner Thomas B. Considine, Department of Banking & Insurance
Robert M Czech, Chair, Civil Service Commission
Dudley Burdge, Representative for Local Government Employees

Absent: Patrick Nowlan, Representative for State Government Employees

ALSO PRESENT: 

Diane Weeden, Deputy Attorney General
Florence J. Sheppard, Acting Director, Division of Pensions and Benefits
David Pointer, Manager, Policy, Planning and Operations
Jean Williamson, Acting Secretary
Barb Scherer, State Health Benefits Program
Dave Perry, Horizon Blue Cross Blue Shield New Jersey (Horizon BCBSNJ)
Wendy Burns, Horizon BCBSNJ
Rosemary Middlebrook, Horizon BCBSNJ
Sue Rizzini, Magellan Health Services
Lou Parrott, Magellan Health Services
Angela Pearson, Medco Health Solutions
Bhavesh B Modi, RPh, Medco Health Solutions
Jeff Brown, Medco Health Solutions
Katherine Impellizzeri, Aetna Health Plan
Patrick Currie, Aetna Health Plan
Dr. Kay Eckroth, Aetna Dental Plan Director (via telephone)
Pat Buzbee, Aetna Dental Network Manager (via telephone)

Resolutions A (Closed Session) and B (Executive Session) – were read in their entirety.

Meeting No. 519, November 9, 2011:Commissioner Czech made a motion to accept the minutes. Chairperson Culliton seconded the motion.  All voted in favor.  

 ISSUES

  1. Carrier Updates:
  2. Aetna – Katherine Impellizzeri provided an overview of changes to the Aetna’s Active Dental Expense Plan (DEP).  The DEP will move from a passive to an active PPO effective January 1, 2012.  Commissioner Burdge requested the amount of growth of the network during the last year for New Jersey and Pennsylvania.  Ms. Impellizzeri agreed to provide that information.

    Medco –Angela Pearson, Medco Health Solutions gave a presentation concerning Medco’s Off-patent Strategy for 2012.  She advised the Commission there are six brand name drugs that will be going off patent in 2012 that could result in a significant savings to the State Health Benefits Program (SHBP).   She said Medco plans to do a Generic Pre-Launch Notification to create early awareness of the upcoming generic availability.  Members who use retail pharmacies for their prescriptions will receive targeted mailings that will encourage them to use the Medco Mail Order Pharmacy.  In addition, four to six months prior to the expected generic availability, top prescribing physicians will receive pre-notification faxes to educate them about the upcoming generic availability.  One month prior to the generic launch, another notice will be sent to physicians to request that they allow for generic substitution on existing prescriptions that require brands to be dispensed.  Medco will offer off-patent copay waivers (up to $25) for selected brand prescriptions that will soon become generic, when these prescriptions are moved from a retail pharmacy to the Medco Pharmacy.  Off-patent copay waivers are available six months prior to the generic launch of selected brands, including: Lipitor in 2011and in 2012: Lexapro®. Plavix®, Singulair®, and Actos® Diovan®.   Ms. Pearson went on to explain that Plavix is going off patent in May 2012 and that it is unique as compared to the other drugs because there are going to be multiple generic manufacturers that are going to launch at the same time.  Therefore it is expected that the price of generic Plavix will go down quicker than other drugs when the patent expires.  Medco created a unique strategy for Plavix.  They are going to give the member an opportunity to fill a 90 day mail order prescription in two fills.  The first fill would dispense enough quantity of the brand medication to cover two weeks post launch.  So two weeks after the generic becomes available Medco will dispense the balance of that prescription with the generic drug.  The members’ copayment will be prorated so the member and the plan will save money.  This strategy will be done for a short period of time until the market stabilizes.  The program is completely voluntary.  A notice will be sent to the members advising them of the generic availability, time frame and how the proration of the copay works.   Chairperson Culliton made a motion to elect to participate in Medco’s Off-patent Strategy.   Commissioner Czech seconded the motion.  All voted in favor.

    Bhavesh B Modi, RPh, Medco Health Solutions advised the Commission of Clinical Update Information for the use of Cialis.  On October 6, 2011, the FDA approved a new indication for Cialis as a once a day medication for the treatment of men who have both erectile dysfunction and the signs and symptoms of benign prostatic hyperplasia (BPH).  The FDA also approved Cialis as a once daily medication for the treatment of the signs and symptoms of BPH.  The daily doses available for treating BPH are 5mg and 2.5 mg.  No other erectile dysfunction drugs were approved by the FDA for BPH at this time.  Chairperson Culliton made a motion to require a coverage review and to keep the edits for the dispensing limits of 4 pills per month/12 pills per 90 days, so there is some control over the use of these drugs.  Commissioner Burdge seconded the motion.  All voted in favor. 

    David Pointer informed the Commission that the State Health Benefits Program will lose its grandfathered status as of January 1, 2012 under Federal Health Care Reform which will require a change to the member appeal process.  Once members have exhausted the two step internal medical appeal process with carriers they will have the option to appeal to an independent review organization (IRO).   Appeals for medical claims incurred prior to January 1, 2012 and administrative appeals will continue to come to the Commission. 

    Mr. Pointer reported that open enrollment processing is completed.  A total of 220 members switched to the new plans.  There are 18 active members enrolled in the HDHP:  twelve are State monthly employees, four are State biweekly employees and two are Local government employees.         

  3. Mental Health Parity –Mr. Pointer advised the Commission the purpose of the exemption is to preserve the day limits of the plan; there are no dollar limits.  Commissioner Czech made a motion to file for the exemption from the HIPAA mental health parity requirements.  Chairperson Culliton seconded the motion.  Motion passed. (Vote 3: 1: 0, Commissioner Burdge voted nay).

  4. Surcharge –The Commission was advised the Surcharge is set by the State Treasurer and this item was listed as “For Approval” rather than an FYI.

  5. Medical RFP – Florence Sheppard, Acting Director stated she would answer any questions the Commissioners had regarding her memo recommending the release of a medical RFP.  The SHBC members will have the opportunity to review the draft at the Division during a specified time period.  Commissioner Burdge questioned why the RFP was being done through the Division of Purchase and Property.  Ms. Sheppard said in the past the Division of Purchase and Property’s regulations did not permit a best and final offer (BAFO); its regulations now permit a BAFO.  In addition, the Division no longer has the staff available to do the RFP.  Furthermore, the Division of Purchase and Property has made significant technical improvements to allow for electronic publishing of RFPs, electronic addendum updates and electronic question submission from bidders and responses to those questions.  Commissioner Burdge asked what relationship the SEHBC had with this bid.  Ms. Sheppard said there will be a meeting to discuss it with them.  Mr. Pointer pointed out the intent is to release the RFP in January 2012 or early February.  Commissioner Czech made a motion to approve the Division of Purchase and Property to issue a Release of a Request for Proposals (RFP) for Medical Plans with the option to continue with a one year extension available under the current contract if the bidders’ proposals don’t meet the requirements.  Chairperson Culliton seconded the motion. All voted in favor. Commissioner Burdge voted in favor with the understanding there is going to be a review process. 

  6. 2012 Revised Meeting Schedule – Jean Williamson advised the Commission due to a conflict in the Civil Service Commission’s 2012 schedule, there is a request to change the January and February meeting time to begin at 1:00 PM.  Chairperson Culliton made a motion to approve the change.  Commissioner Burdge seconded the motion. All voted in favor. 

Chairperson Culliton moved to take a short break at 11:15 AM.  The meeting reconvened at 11:22 AM.

The following cases, due to HIPAA regulations, are heard in closed session, with motions and voting done in closed session.

Chairperson Culliton made a motion to go into Closed Session under Resolution A.  Commissioner Burdge seconded the motion.  All voted in favor.

Case #SH121103 – This Aetna Dental appeal concerned the denial of coverage for Osseious Surgery. Dr. Kay Eckroth, Aetna Dental Plan Director provided overview of the appeal.  Based on the consultant’s review of periodontal charting from 1995 and x-rays October 28, 2010, a benefit determination could not be concluded for either full quadrant or partial quadrant of osseous surgery.  Chairperson Culliton made a motion to deny this appeal based on Aetna’s presentation and the documents that were submitted.  Commissioner Czech seconded the motion.  Motion passed. (Vote 3: 0: 1, Commissioner Burdge abstained).

Case #SH121102 – This Medco appeal concerned the denial of reimbursement for Lansoprozole 15mg capsules.  Bhavesh B Modi, RPh, Medco Health Solutions provided an overview of the appeal.  He said Lansoprozole is available over-the-counter in a 15 mg capsule.  Chairperson Culliton made a motion to deny this appeal because over-the-counter medications are excluded under the prescription drug plan.  Commissioner Czech seconded the motion.  Motion passed. (Vote 4: 0: 0).

Case# SH121101 This Horizon NJ DIRECT10/Magellan appeal concerned the denial of benefits for expenses for residential treatment for an eating disorder at Timberline Knolls.  Chairperson Culliton said in reviewing the documents she noted the member’s mother indicated there was an underlying diagnosis that required treatment in this facility.  She did not see that issue addressed by Magellan or Horizon.  Dr. Lou Parrott Medical Director, Magellan Health Services responded the primary diagnosis for admission was an eating disorder.  There were secondary diagnoses but they also did not meet the criteria for residential treatment.  Sue Rizzini, Magellan Health Services, said the appropriate level of care would have been partial hospitalization.  She added Magellan was not able to clarify what the facility was billing them for and what the facility was actually charging the member.  Commissioner Allen-Ware made a motion to go into Executive Session under Resolution B.  Chairperson Culliton seconded the motion.  All voted in favor.  Upon return from Executive Session, Chairperson Culliton made a motion to table this appeal to allow Magellan time to reach out to the facility again to obtain as much information as possible in terms of the costs, so that the Commission can consider whether or not any amounts should be paid to the petitioner.  Ms. Rizzini mentioned the patient had met the annual benefit period maximum.  A discussion ensued on the primary and secondary diagnoses.  Mr. Pointer asked what is to be gained by finding out what the actual bill is if the annual benefit period maximum was met. There was a brief discussion regarding an eating disorder appeal which the School Employees’ Health Benefits Commission sent to the Office of Administrative Law.  Chairperson Culliton withdrew her motion.  She made a motion to deny the appeal based on the annual benefit period maximum having been met.  Commissioner Czech seconded the motion.  Chairperson Culliton amended the motion to deny the appeal because 1) the member exceeded the limit based upon the fact that it’s not a biologically based mental illness and 2) the residential treatment was not medically necessary.  Commissioner Czech seconded the motion.  A discussion ensued and Commissioner Allen-Ware made a motion to go into Executive Session.  Chairperson Culliton seconded the motion and all voted in favor.  Upon return from Executive Session, Chairperson Culliton withdrew her motion and substituted it with a motion to table the matter to permit Magellan to do the second level appeal regarding the issue of medical necessity.  Commissioner Czech seconded the motion.  Motion passed. (Vote 3: 1: 0, Commissioner Burdge voted nay).

Case #SH121104 – This Division appeal concerned a denial of a refund of the employee contribution towards health benefits premiums.  David Pointer advised the Commission the only way to waive coverage is to complete an application waiving it.  He added the member told her employer she was waiving her coverage when she became a full time employee, but the employer did not direct her to complete an application.  Therefore, the issue is with her Employer and not the Commission.  Commissioner Czech made a motion to deny this appeal because an application was not completed and received.  Chairperson Culliton seconded the motion.  Motion passed. (Vote 4: 0: 0).

Case #SH121105 – Final Administrative Determination (FAD) – Chairperson Culliton made a motion to accept the FAD draft concerning the denial of State Health Benefits coverage.  Commissioner Czech seconded the motion. Motion passed. (Vote 3: 0: 1, Commissioner Burdge abstained).

Case #SH111106 – A settlement offer was before the Commission in a case involving a denial of benefits for an injury deemed work related. The lien amount was $6,281.21 and the proposed settlement amount was $1,500.00.  Chairperson Culliton made a motion to accept the settlement amount of $1,500.00.  Commissioner Burdge seconded the motion. All voted in favor.

Case #SH111107 – A settlement offer was before the Commission in a case involving a denial of benefits for an injury deemed work related. The lien amount was $2,550.28 and the proposed settlement amount was $1,750.00.  Chairperson Culliton made a motion to accept the settlement amount of $1,750.00. Commissioner Burdge seconded the motion. All voted in favor.

Case #SH111108 – A settlement offer was before the Commission in a case involving a denial of benefits for an injury deemed work related. The lien amount was $4,611.39 and the proposed settlement amount was $4,000.00.  Chairperson Culliton made a motion to accept the settlement amount of $4,000.00. Commissioner Burdge seconded the motion. All voted in favor.

There being no further appeals or business, a motion was made to return to open session and to adjourn by Commissioner Czech and seconded by Commissioner Burdge. All voted in favor.
The State Health Benefits Commission meeting was adjourned at 12:45 PM.

Respectfully submitted,


Jean M. Williamson, CEBS
Acting Secretary
State Health Benefits Commission

 

 

 


 

 
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