State pushes back deadline in CGI contract
"Our focus is more on getting the work done and making sure it gets done right," said Mark Larson, commissioner of the Department of Vermont Health Access in an interview Tuesday.
A May 21 deadline for a component that will allow users or customer service representatives to make changes to a person's coverage was written into a revised contract signed by the state and CGI in early April.
Larson said the state agreed to give CGI until June 8 to deliver the change of circumstance function.
If the delay was CGI's fault, then the state could begin imposing penalties that grow each day until the function is delivered. Larson would not say if penalizing CGI was an option, or if the state shares some of the blame for the latest delay.
"If we focused on (the deadline) and what we could have or couldn't have done under the contact, we would've been distracting ourselves from what we need to get done," Larson said.
The delay is to allow for continued testing of the change of circumstance function and to train Vermont Health Connect workers on how to use it, he said.
There are about 10,000 Vermonters who need to make a change in their coverage and are still waiting to complete the process. That is 2,000 more than needed to make a change at the end of April.
Some people awaiting a change in their coverage initiated the process last year within weeks of the Oct. 1, 2013, launch of the website.
There are roughly 28,000 people paying commercial premiums through Vermont Health Connect. Several thousand of the people seeking a change of circumstance might be enrolled in Medicaid, but the majority are paying a commercial premium.
"We are not seeing the kind of pace in resolving cases that we want to see, and that's why getting the new functionality is so important to us," Larson said.
Currently, the only way to correct a mistake or update one's coverage to reflect any number of changes - such as a boost in income, a change in address or to add a new dependent - is to call the Vermont Health Connect call center. Then a state worker must manually make the changes. The information must then be updated by the third-party premium processor, the insurer and the IRS if the change affects someone's premium tax credit.
Automating the change of circumstance process will allow users to make immediate changes in their coverage online. It will also allow Vermont Health Connect staff to make those changes more quickly for users who don't want to go through the website.
Vermont negotiated discounts into its most recent contract revision that allow the state to penalize CGI up to $2 million for missed deadlines. The contract is worth $84 million. The state has already assessed $5 million in damages for previous missed deadlines.
The new penalties would be imposed by withholding 12.5 percent of the fee for a component piece of the contract that isn't completed on time. The change of circumstance function is worth $3.4 million, so the penalty would be roughly $425,000.
CGI can earn part of that penalty back by completing the component within 28 days of the missed deadline. But instead of starting the clock on penalties, Vermont chose to push back the deadline.
"That was a date that was chosen in the contact, but what I'm saying now is that we have mutually agreed to change that date based on what we think is a more reasonable date to get the project done and done well," Larson said.
For the 10,000 Vermonters waiting to make changes to their coverage the process can be extremely frustrating. Changes made in the Vermont Health Connect system might take weeks or even months to be reflected in their insurance coverage.
In addition, it can take multiple calls to identify a problem in someone's coverage, and some changes require a person to select a different plan, which can be a difficult decision to make quickly over the phone.
Larson encouraged people having problems to call the call center and work through them with a customer service representative.
When a person initiated their request for a change in coverage is, "one factor we consider amongst others," Larson said.
His top priority is addressing cases in which an individual could see a disruption in coverage if the issue isn't resolved. Those cases can be resolved in as little as 24 hours, he said.
For people that are covered, but might be in the wrong plan, and therefore overpaying for health care services, Larson said it's his understanding that people who may be overpaying for services while they await a change in their coverage will somehow be compensated and the changes will be applied retroactively.
The next major deadline in the revised contract is the small business component, which will allow businesses to purchase coverage for their employees online, which is due July 2.
Asked if he was confident about meeting that deadline, Larson said, "We have a lot of work left to do and we continue to monitor that on a daily basis, but it's going to be a significant effort."
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