Specifications include, but are not limited to: a. Obtaining necessary information regarding health plans offered by carriers with more than one percent accident and health market share, based upon OIC’s most recent annual market information report, and health plans offered to public employees under chapter 41.05 RCW. OIC anticipates that the bulk of this information will be obtained through a data call to carriers. The Contractor will be responsible for development of the data call, in consultation with OIC. OIC will issue the data call. The Contractor will analyze the data submitted by carriers as well as other relevant data sources identified by the Contractor: • How health plan benefit designs define maternity care services. For purposes of this RFP, maternity care services include but are not limited to prenatal care, childbirth and delivery, postpartum care, and medically necessary supplies for home birth. • If and to what extent maternity care services are subject to deductibles and other cost-sharing requirements. • Which maternity care services are considered preventive services under section 2713 of the federal public health services act (42 U.S.C. Sec. 300gg et seq.) and which services are exempt from cost-sharing on the effective date of this section under the implementation of federal regulations. • The five (5) most commonly used maternity care reimbursement methodologies used by each carrier. • When bundle payment reimbursement methodologies are used which, specific services are included in the bundled payment. b. Estimate the total and per member per month cost impact on health plan rates of eliminating cost-sharing for maternity care services in full, or for prenatal care only, for the following markets: • Individual health plans other than cascade select plans • Cascade select health plans • Small group health plans • Large group health plans • Health plans offered to public employees under chapter 41.05 20 RCW • All health plans in the aggregate. 1.2.2 Provision of actuarial analysis and advice related to options to reduce or eliminate costsharing for maternity care services in commercial health plans and public employee health plans offered in Washington state. Actuarial analysis will include determination of the potential impacts on health plan design, actuarial values, and premium rates if cost-sharing were reduced or eliminated for the following services: a. Prenatal care services b. Delivery; and c. Postpartum care services 1.2.3 Analysis of similar maternity care cost-sharing reduction or elimination policies in other states. Contractor will provide an analysis of policies to reduce or eliminate maternity care costsharing in use or under consideration in other states. For each policy included in the analysis under 1.2.3 the contractor will include: a. A description of the state’s policy. b. Compilation and analysis of any research or other findings related to the implementation and outcomes of the policy. c. Based upon information gained through objective 1.2.2, analysis of potential impacts in Washington state on health care pricing, health services utilization, health care affordability and access to health care if such a strategy were adopted in Washington state. The analysis will include any economic modeling or actuarial analysis necessary to identify potential impacts.
