Category Archives: Health Care

State releases amended Gruber contract

State officials released an amended contract with MIT economist Jonathan Gruber Tuesday evening, lowering the maximum amount payable to $280,000.

Gruber had a personal services contract with Vermont that was to pay him as much as $400,000 to test economic models related to Gov. Peter Shumlin’s universal, publicly-financed health care proposal.

But his work has come under fire, and a number of high profile Republicans have called for the contract to be terminated because of the questionable comments Gruber made on several occasions in the last several years.

During a 2011 hearing of the House Health Care Committee, then-Chairman Mark Larson read aloud comments written by John McClaughry, a former state senator and policy advisor for President Ronald Reagan. McClaughry, in his published commentary, said Shumlin’s health care proposal would lead to higher taxes, ballooning costs, poor health care facilities, disgruntled providers and long waits for care, among other concerns.

“Was this written by my adolescent children by any chance?” Gruber asks on a video recorded by True North Reports and released last week to the online site Watchdog.org.

In other videos that came to light last week Gruber credited “the stupidity of the American voter” with getting the federal Affordable Care Act passed.

The contract allows the the state to use the Gruber Microsimulation Model that Gruber developed to simulate the implementation of Shumlin’s plan and test various financing mechanisms.

State officials announced last week that Gruber had agreed to forego any further payments for the work he was contracted to do. However, graduate assistants will continue to be paid and carry out work on behalf of the state.

Some Republicans had maintained that the original contract required official changes, and said Gruber’s “handshake agreement” with Lawrence Miller, Shumlin’s chief of health care reform, was not sufficient.

The amended contract reflects the change change in pay for Gruber.

See the contract below:

Another GOP lawmaker appears on Fox

Rutland County Sen. Kevin Mullin is the latest GOP lawmaker in Vermont to appear on Fox News to address comments by MIT economist Jonathan Gruber that have come to light in recent weeks. Senate Minority Leader Joe Benning of Caledonia County appeared on the network earlier this week.

Mullin said dealing with the fallout of Gruber’s comments is “a complicated issue.” The Shumlin administration announced Wednesday that Gruber will no longer receive payment for his work, but his team of researchers and graduate assistants will continue to be paid.

“The state’s in the position where the work is almost finished, but it’s going to be a work that the public is not going to have confidence in,” Mullin said.

During a 2011 hearing of the House Health Care Committee, then-Chairman Mark Larson read aloud comments written by John McClaughry, a former state senator and policy advisor for President Ronald Reagan. McClaughry, in his published commentary, said Shumlin’s health care proposal would lead to higher taxes, ballooning costs, poor health care facilities, disgruntled providers and long waits for care, among other concerns.

“Was this written by my adolescent children by any chance?” Gruber asks on a video recorded by True North Reports and released last week to the online site Watchdog.org.

In other videos that came to light last week Gruber credited “the stupidity of the American voter” with getting the federal Affordable Care Act passed.

Asked if Vermonters could trust Gruber, Mullin’s answer was clear. “Absolutely not,” he said.

“No one in Vermont is defending Professor Gruber. Everyone is very, very disappointed and we’re trying to make the best of a very bad situation,” Mullin said.

What would Mullin say to Gruber if given that opportunity?

“I would just let him know that he should be ashamed. That despite his obvious abilities as far as an economist and a mathematician, that the American people can make informed decisions, that it needs to be a transparent and open government and that’s not the way to conduct oneself,” Mullin said.

 

Gruber to receive no additional pay from state

MONTPELIER — Jonathan Gruber, the contractor under fire for degrading remarks he’s made in the past several years about voters and a Vermont commentator, will be expected to complete economic modeling for the state but will not receive any more pay, according to state officials.

Chief of Health Care Reform Lawrence Miller reiterated the Shumlin administration’s disappointment with Gruber’s comments on Wednesday. He also said Gruber has been informed that he will not receive further payment on the $400,000 contracted agreed to in July.

Gruber and his team have been paid a total of $160,000 so far, according to Scott Coriell, a spokesman for Gov. Peter Shumlin.

“As the Governor and I have said, the comments by Mr. Gruber are offensive, inappropriate and do not reflect the thinking of this administration or how we do things in Vermont. As we have also said, we need solid economic modeling in order to move forward with health care reform,” Miller said in a statement to the Vermont Press Bureau Wednesday afternoon. “I have told Mr. Gruber that I expect his team to complete the work that we need to provide the legislature and Vermonters with a public health care financing plan. I’ve informed Mr. Gruber that we will not be paying him any further for his part in completing that work.”

Gruber, a Massachusetts Institute of Technology economist, has a personal services contract with Vermont that will pay him up to $400,000 to test economic models related to Shumlin’s universal, publicly-financed health care proposal. Another $50,000 can be used to subcontract with Moody’s Analytics for macroeconomic modeling.

The contract allows the the state to use the Gruber Microsimulation Model that Gruber developed to simulate the implementation of Shumlin’s plan and test various financing mechanisms.

Gruber, who has served as a health care advisor for the Obama administration, has also inked contracts with the federal government and other states for his unique economic modeling capabilities.

His work is now being questioned, and calls for his firing becoming more frequent, especially from Republicans in Vermont and elsewhere, because of questionable comments he has made on several occasions in the last several years.

During a 2011 hearing of the House Health Care Committee, then-Chairman Mark Larson read aloud comments written by John McClaughry, a former state senator and policy advisor for President Ronald Reagan. McClaughry, in his published commentary, said Shumlin’s health care proposal would lead to higher taxes, ballooning costs, poor health care facilities, disgruntled providers and long waits for care, among other concerns.

“Was this written by my adolescent children by any chance?” Gruber asks on a video recorded by True North Reports and released last week to the online site Watchdog.org.

In other videos that came to light last week Gruber credited “the stupidity of the American voter” with getting the federal Affordable Care Act passed.

In his statement, Miller said the work completed by Gruber will be verified by independent sources.

“As planned, following the completion of the financing plan, the assumptions and results will be fully evaluated by the other economists, including the joint fiscal office, who are advising the administration and the legislature on this matter,” Miller said.

Gruber declined to comment via email Wednesday.

Benning calls for Gruber’s termination on Fox

Senate Minority leader Joe Benning appeared on Fox News’ “On the Record With Greta Van Susteran” Tuesday to discuss recent comments by MIT economist Jonathan Gruber.

The chorus calling for Gruber’s ouster as a state contractor has been growing louder in Vermont this week. Campaign for Vermont, a nonprofit advocacy group that claims to be nonpartisan, directed people by Twitter to its website to sign a petition in favor of terminating Gruber’s contract. And a trio of House Republicans released a letter to Shumlin on Monday calling on the governor to do just that.

Gruber’s work is being questioned because of questionable comments he has made on several occasions in the last several years.

During a 2011 hearing of the House Health Care Committee, then-Chairman Mark Larson read aloud comments written by John McClaughry, a former state senator and policy advisor for President Ronald Reagan. McClaughry, in his published commentary, said Gov. Peter Shumlin’s single payer health care proposal would lead to higher taxes, ballooning costs, poor health care facilities, disgruntled providers and long waits for care, among other concerns.

“Was this written by my adolescent children by any chance?” Gruber asks on a video recorded by True North Reports and released last week to the online site Watchdog.org.

In other videos that came to light last week Gruber credited “the stupidity of the American voter” with getting the federal Affordable Care Act passed.

Gruber has a personal services contract with Vermont that will pay him up to $400,000 to test economic models related to Shumlin’s universal, publicly-financed health care proposal, often referred to as a single payer system. Another $50,000 can be used to subcontract with Moody’s Analytics for macroeconomic modeling.

The contract allows the the state to use the Gruber Microsimulation Model that Gruber developed to simulate the implementation of Shumlin’s plan and test various financing mechanisms.

Gruber, who has served as a health care advisor for the Obama administration, has also inked contracts with the federal government and other states for his unique economic modeling capabilities.

Watch Benning’s appearance on Fox below:

State to retain Gruber through end of contract

Vermont Gov. Peter Shumlin said Monday that a state contractor under fire for derisive comments he has made about American voters and a Vermont commentator will not have his state contract terminated despite calls to do so by Republicans.

Jonathan Gruber, a Massachusetts Institute of Technology economist, has a personal services contract with Vermont that will pay him up to $400,000 to test economic models related to Shumlin’s universal, publicly-financed health care proposal, often referred to as a single payer system. Another $50,000 can be used to subcontract with Moody’s Analytics for macroeconomic modeling.

The contract allows the the state to use the Gruber Microsimulation Model that Gruber developed to simulate the implementation of Shumlin’s plan and test various financing mechanisms. The contract began in July and runs through Feb. 15, with an option to renew the contract for up to one year.

“I don’t see us doing that,” said Lawrence Miller, Shumlin’s chief of health care reform.

Gruber, who has served as a health care advisor for the Obama administration, has also inked contracts with the federal government and other states for his unique economic modeling capabilities.

The chorus calling for Gruber’s ouster as a state contractor grew louder in Vermont on Monday. Campaign for Vermont, a nonprofit advocacy group that claims to be nonpartisan, directed people by Twitter to its website to sign a petition in favor of terminating Gruber’s contract.

And a trio of House Republicans released a letter to Shumlin on Monday calling on the governor to do just that.

“This arrogant and disrespectful attitude is totally unacceptable and will undermine the entire process and debate going forward if Mr. Gruber continues. No one who speaks of Americans, and therefore Vermonters, as stupid, or who boasts of a process that has a “lack of transparency” should remain under contract, being paid by the very people he has insulted,” wrote Reps. Patti Komline of Dorset, Heidi Scheuermann of Stowe and Kurt Wright of Burlington. “In our opinion, Mr. Gruber has disqualified himself and we urge you to terminate his contract immediately. Failure to do so will only further erode Vermonters’ confidence in a process that has already left much to be desired.”

His work is now being questioned, and calls for his firing becoming more frequent, especially from Republicans in Vermont and elsewhere, because of questionable comments he has made on several occasions in the last several years.

Dr. Jonathan Gruber

Dr. Jonathan Gruber

During a 2011 hearing of the House Health Care Committee, then-Chairman Mark Larson read aloud comments written by John McClaughry, a former state senator and policy advisor for President Ronald Reagan. McClaughry, in his published commentary, said Shumlin’s health care proposal would lead to higher taxes, ballooning costs, poor health care facilities, disgruntled providers and long waits for care, among other concerns.

“Was this written by my adolescent children by any chance?” Gruber asks on a video recorded by True North Reports and released last week to the online site Watchdog.org.

In other videos that came to light last week Gruber credited “the stupidity of the American voter” with getting the federal Affordable Care Act passed.

Shumlin denounced Gruber’s comments on Monday but said Gruber will continue to test potential financing options for his health care proposal. Shumlin will reveal a financing proposal to lawmakers and the public in January.

“I share the dismay and outrage about his comments, and for me it’s not just what he said, it’s that he actually thinks this stuff. It’s not the way we do things in Vermont. It’s repugnant to everything that we do in Vermont and I’m shocked,” Shumlin said.

A clause in Gruber’s contract with the state says he “may advise the Governor on policy matters related to the project to assist the Governor in deliberations and decision-making related to the project.” Shumlin said Gruber has played no role in shaping policy, however.

“It’s our plan, not his. It’s our policy, it’s our hope for the future and it’s our plan. We’ve used him as a calculator not a policy advisor,” Shumlin said.

The governor said he has “never met him in my life,” but did participate in at least one group conference call regarding health care policy with Gruber. Shumlin said he could not remember if Gruber spoke during that call.

Another clause calls for weekly meetings, either in person or by conference call, to review progress on contract work. Michael Costa, the tax expert who has taken the lead role in developing Shumlin’s financing plan, said Monday those meetings have mostly taken place by telephone. Gruber has not been to Vermont since before the contract was signed, according to Costa.

Despite the comments, Gruber will be expected to finish out the contract, which is already about 90 percent complete. Shumlin said he is “grateful” Gruber’s work will soon end, but the work is needed to ensure the single payer health care proposal will not harm the state’s economy.

“He is, in effect, the calculator of the options that we put forth to replace premiums with a system that is based on ability to pay. We gave him a series of options that we thought might work,” Shumlin said. “He is, in effect, our calculator. He does not do policy for us.”

“He is one of the very few people in America that has a calculator that will give us information that we can believe in,” he added.

Wright, in a statement about the GOP House members’ letter to Shumlin, said allowing Gruber to continue working will hurt Shumlin politically.

“Governor Shumlin won a razor-thin plurality on Election Day … signaling a lack of confidence from Vermonters on a whole host of issues. This crisis of confidence will certainly be magnified if Mr. Gruber continues in any capacity, and I believe will lead to further erosion of public support for the Governor and his policies,” Wright said.

Gruber’s analysis is critical to meeting statutory requirements, however, according to Shumlin.

“His comments are repugnant and unimaginably disappointing. I certainly wouldn’t consider him for future work, but we certainly need him to complete the work that we paid him to do,” Shumlin said. “I’m grateful that this project with him his wrapping up soon. I don’t like working with people that say things like that about the rest of us.”

Gruber, reached by email Monday, declined to comment.

“Thanks for the opportunity to respond but I have no comment at this point,” he wrote.

State officials have “high” confidence in revamped health site

MONTPELIER — State officials have a “high level” of confidence that an improved Vermont Health Connect website will re-launch for the public Saturday in time for the open enrollment process.

Chief of Health Care Reform Lawrence Miller said security upgrades were completed about three weeks ago and the state is reconnected to the federal data hub. The state chose to disconnect from the hub in mid-September before the Centers for Medicaid and Medicare, the federal entity that oversees state exchanges, forced them to disconnect because of security concerns.

Miller said the state now meets all of CMS’s security requirements.

Lawrence Miller

Lawrence Miller

Online health insurance marketplaces, known as exchanges, are required by the federal Affordable Care Act. The state chose to build its own rather than join an exchange created by the federal government. Since launching in October 2013, however, Vermont’s site has lacked core functions and experienced technological problems.

Miller said Tuesday that the state’s contractor, Optum, which replaced original contractor CGI earlier this year, has made a series of improvements to the Vermont Health Connect site’s design and performance. Obsolete content has been removed. The state will “meet every expectation” it had when open enrollment begins on Nov. 15.

Gov. Peter Shumlin, speaking at an unrelated news conference Monday, said he is “cautiously optimistic” the site will perform as expected on Saturday.

“My team believes that when we light up the website it’s going to be able to do two things that we weren’t secure about before,” Shumlin said. “The first is obviously the security concerns have been worked out, and that’s a big deal. The second is that we believe the functionality is going to be much better.”

State officials, including Miller, chief of health care reform for Gov. Peter Shumlin, Harry Chen, acting secretary of the Agency of Human Services and Stephanie Beck, director of health care operations at AHS, are expected to brief reporters today on developments with VHC.

Those looking to renew their policies for 2015 will be able to see plan options online an download renewal forms. Those forms will be entered manually by staff, however, and not processed online. State officials announced that process over the summer.VHC

Existing customers were given the option of authorizing the state to check subsidy eligibility for a five year period when they first signed up for an exchange plan. Because there were no material changes to health connect insurance plans, aside from pricing, those who granted the state that authority will be “auto-mapped” into the 2015 version of their health plan and receive updated billing information.

Those that did not provide that authorization have been sent letters asking them to fill out a form and send it back allowing the state to check for subsidy qualification.

A portion of the website went live on Oct. 15 that outlines the 2015 health plans, rules and a subsidy calculator. The site also provides renewal forms that can be downloaded, filled out and returned by mail. Those seeking to renew plans can also contact the call center or visit a trained navigator.

The state is expecting between 3,000 and 8,000 people to enroll in exchange plans, offered either by Blue Cross Blue Shield of Vermont or MVP, for the first time. Those first-time applicants will be able to apply online.

The questions and options for new enrollees have been revised to reduce the occurrence of errors, Miller said, and are now more in line with how a navigator or call center staff would help fill out the forms.

“Those question sets have be updated, including reordered in some cases, and reworded so that it’s much more clear,” Miller said. “I think we will have a much lower error rate with those things.”

Other core functions, including the so-called change of circumstance, will remain offline until after the close of open enrollment on Feb. 15. Users who need to change personal information, such as their address or marital status, will continue to undergo a manual process rather than the faster, automated system the website was initially expected to offer.

Additionally, small business employees will still not be allowed to enroll through the website and must obtain insurance directly from carriers.

“It needs to be tested out, and that includes the carriers. I don’t see that testing being able to start, from a capacity standpoint, until Feb. 15,” the official said.

The transition from CGI to Optum required a stoppage of all development work, meaning further upgrades to the system, including automated change of circumstance and small business enrollment, will not be added until after the open enrollment period.

The state expects about 15 percent of those already enrolled in exchange plans to consider a new plan or some change to their benefits, which is the industry average each year. But because about 60 percent of those enrolled receive a subsidy, the state has prepared for up to 60 percent of enrollees seeking a change.

“It would be foolish for us not to provide for that,” Miller said.
About 220 Optum employees who are currently working on manual change of circumstance requests will shift Saturday to entering no-change renewals into the system, according to the Miller.

Employees from Maximus, the contractor operating the VHC call center, will also be available. And the state reached out to AHS and Department of Information and Innovation staff for voluntary overtime. The volunteer effort is different from the forced overtime the state implemented last year for some employees.

“Last year, you’ll recall, we did impose mandatory overtime,” Miller said. “That went over really, really badly. Canceling Christmas pisses people off, and it’s just not enough people,” Miller said.

Those that volunteer are being screened for their skill sets and directed accordingly. Some will work a few extra hours during the week, while others will work on weekends.

Optum’s current contract, known as a time and materials contract, is worth $29 million. It includes completing some work left behind by CGI when the firm and the state parted ways. It also includes the manual entry of data and some of the development work to get the site ready for open enrollment.

The contract will likely be amended and expanded after the open enrollment period to complete development work on the missing functions. Miller said it is unclear what the full amount of the contract will be.

CMS will provide an extension on developments for Vermont, as it has for Massachusetts and Maryland, Miller said.

Despite the “pretty high” level of confidence in the site, some risk remains, Miller said. The development and test environment for the site cannot completely mimic a live environment. And there could still be some “downstream risks associated with connectively with the federal data hub,” according to Miller.

The site was deployed internally, with public access still blocked, on Monday night. It is currently undergoing “a heavy security scan” and performance evaluation. Testing will continue Wednesday before the site is opened to customer service representatives on Thursday. On Saturday the public will have access.

neal.goswami@timesargus.com​

State warned in June that exchange faced disconnection

MONTPELIER — State officials knew in early June that the state’s online health insurance marketplace faced possible disconnection from the federal data hub because of ongoing security shortcomings, according to documents obtained through a public records request.

Department of Vermont Health Access Commissioner Mark Larson received a letter, dated June 10, from the Centers for Medicare and Medicaid Services explaining that Vermont Health Connect could be disconnected from the federal data hub by Sept. 8 if security shortcomings were not resolved.

State officials eventually took the exchange site offline on the evening of Sept. 15, but did so voluntarily, according to Lawrence Miller, a special advisor to Gov. Peter Shumlin and the state’s chief of health care reform.

According to CMS’ letter, the Vermont exchange fared poorly in two quarterly reviews, which prompted the warning and threat of disconnection.

“[B]ased upon CMS’ evaluation of your quarterly (plan of action and milestones) for the past two reporting periods, ending January 31, 2014 and March 31, 2014, we have identified a significant number of open high security findings and/or open moderate findings that potentially could present risk to the security of the Hub,” the letter states.

Lawrence Miller

Lawrence Miller

The letter acknowledged progress the state was making in addressing security threats, but set a deadline of Sept. 8 to complete that work. It noted, however, that the state “will be disconnected from the Hub and required to submit new security documentation to regain the (Authority to Connect)” if improvements were not completed.

“CMS continues to monitor your mitigation strategies and corrective action plans related to your system’s connection to the Hub, and thus believes that the connection to the Hub continues to be secure. As a result, CMS is not immediately disconnecting your state from the Hub, but provides notice pursuant to Section 18 of the Master Interconnection Security Agreement between the parties dated September 20, 20013, that the open high and/or moderate security findings must be addressed … or your state’s (authority to connect) will be terminated,” the letter states.

Miller said Thursday that he could not discuss the threats identified by CMS, but said they are “potential weaknesses.”

“It’s not necessarily identified weaknesses. It’s potential weaknesses,” he said.

According to Miller, the state’s chief information security officer had regular communication with CMS over the next several months. It initially appeared that the state would be granted additional time to complete security improvements, Miller said.

In an email dated Sept. 3 and sent to Larson, Kirk Grothe in CMS’s Office of Information Services, said he believed the state would need until Nov. 3 to complete the required security improvements. However, he also noted that he “was not able to commit to the extended timeline.”VHC

Miller said it initially appeared based on conversations with CMS that the state would be granted additional time. However, it became clear over the next two weeks after Grothe’s email that more time would not be granted. Miller said he and other officials then decided to take Vermont Health Connect offline voluntarily because they knew the deadline would not be met and an extension would not be granted.

“They clearly had an elevated anxiety level from earlier in the year. If nothing had changed, every indication we were getting from our contacts was, ‘Oh yeah, if it takes you a couple more weeks, given the fact that you’re switching over from CGI, you’re working on it, it should be fine.’ And then it wasn’t,” Miller said. “It was a pretty easy decision to say, ‘We don’t have to talk anymore. We’ve got it. We’re going to do this.’”

Miller said officials decided it would be “just silly” to try and accelerate the process of boosting security to meet the Sept. 8 deadline. Officials were also trying to improve other functions on the site while transitioning from original contractor CGI to its new contractor Optum.

“We had the security stuff and we had the performance improvements and the website revisions and were in the middle of the transition from CGI to Optum,” he said. “We were looking at whether we could finish within the time period that we were talking about. We said, ‘No, this isn’t going to happen.’”

Despite learning in June of the security issues, state officials did not disclose the problem until Sept. 16, when Miller, Larson and Shumlin held a news conference to announce that the site was taken offline the previous evening. Miller said he and other state officials were told by CMS that disclosing the potential security threats could encourage hackers to attack the site.

“I have no discomfort with the fact that we did not put that out there based on our conversations with CMS on how to handle these things. You don’t talk about this stuff, period,” he said.

Miller said he has “every reason to believe” the site will be back up before the open enrollment period begins on Nov. 15. The Nov. 3 target identified by CMS is no longer valid, he said, because the work has been combined with other site upgrades.

“That had been what the technical assistance folks at CMS concluded was a reasonable date,” he said.

Larson was dismissed from oversight of Vermont Health Connect last month by Acting Agency of Human Services Secretary Harry Chen. Miller is now responsible for the site’s operations.

 

Read the letter from CMS to former Department of Vermont Health Access Commissioner Mark Larson.

 

Read emails between state officials and the Centers for Medicare and Medicaid Services obtained through a pubic records request concerned the state’s decision to take Vermont Health Connect offline.

 

DVHA has new deputy commissioner

MONTPELIER — A new Department of Vermont Health Access deputy commissioner has been hired to help the state’s troubled exchange.

Lawrence Miller, Gov. Peter Shumlin’s chief of health care reform, said Wednesday that native Vermonter Bob Skowronski will take over the role. Former Deputy Commissioner Lindsey Tucker has been assigned to a new roll in DVHA, he said.

According to Lawrence, Skowronski has “spent his career in health care IT system work.” In recent years he has worked on exchanges in New York, Maryland, Washington, D.C., Rhode Island and Connecticut. He has also worked as Blue Cross Blue Shield in Vermont as director of data management.

Skowronski said Wednesday that his experience in working on exchanges has come from the carrier side in previous work with United Health Care.

“I would consider the carrier … as a customer of the exchange. So, I’ve seen the exchange from a different perspective. The processes are the same, just a different perspective,” he said.

Miller said Skowronski approached him about helping the state fix Vermont Health Connect, which continues to lack key functions.

“He sent me a letter a few weeks ago offering to help at a time in his career when he can step off the corporate track and give back to the community in a way that really takes advantage of his skills and experience,” Miller wrote in an email.

Skowronski said he was preoccupied with his work and only recently began to take not of the challenges in Vermont. When he took stock of the situation at Vermont Health Connect he wanted to help. He said his status as Six Sigma black belt will can help address the site’s shortcomings.

“A few weeks ago, a month ago, I started paying closer attention to news reports … and realized they were experiencing problems that I thought I could help solve,” he said.

Miller said he passed Skowronski’s interest in helping along to Agency of Human Services Secretary Harry Chen and DVHA Commissioner Mark Larson for interviews.

Skowronski, who began work on Tuesday, said he has spent his first two days listening and gauging the needs of stakeholders.

“Clearly Vermonters have had issues with the way Vermont Health Connect was implemented. What I want to start with is their perspective. I want to start with what’s important to Vermonters. I want to work with what’s important to carriers. I want to make sure we’re working closely with the vendors. I want to make sure we’re satisfying various regulators,” he said.

Optum report critical of state, CGI

Vermont’s top health care reform officials are planning a roundtable meeting with reporters this morning to discuss a report by Optum that is critical of both the state and CGI.

Included in the report:

Optum has concluded, based review of the VHC’s Program Management documentation and interviews with both SOV and contractor staff, that the project’s Program Management structure and processes contributed to SOV’s lack of project ownership and CGI’s lack of accountability. Additionally, project
management processes within the program, do not align with industry best practices and are insufficient or ineffective.

As a result CGI has not met its commitments in the contract and the project has not met the expectations of the SOV. The project team’s ability to deliver the remaining contractual requirements is a ‘High’ risk, and as such, immediate corrective action is required.

 

Read the report below:

Hoffer will audit Vermont Health Connect

MONTPELIER — State Auditor Doug Hoffer announced Monday that his office is planning to audit the state’s online health insurance marketplace as the Shumlin administration and its new lead contractor look to fix ongoing technical issues.

Hoffer informed interim Agency of Human Services Secretary Harry Chen in a letter dated Aug. 21 of the pending audit.

Vermont Health Connect, the insurance exchange mandated under the federal Affordable Care Act, has been troubled since its October 2013 launch. Thousands of users who need to change information, such as their address or marital status, must undergo a cumbersome manual process rather than the faster, automated way the website was expected to offer.

Additionally, small business employees are still not allowed to enroll through the website and must obtain insurance directly from carriers. That function is now expected to be available next year at the earliest.

Hoffer said Monday that his office will focus on whether the state has plans in place to correct the site’s shortcomings. A number of reports from various independent contractors have highlighted those shortcomings and provided recommendations on how to address them.

Doug Hoffer

Doug Hoffer

“All of them include a number of recommendations and some of them go back to last year. That’s good, in a way, because we can check and see if adjustments were made,” Hoffer said. “We said, ‘Let’s try to be positive and provide info to the administration, the Legislature and the various departments and see how well they’ve responded.”

Hoffer said his review will begin by late September. That will allow time for an ongoing federal review, conducted by the U.S. Department of Health and Human Services’ Office of Inspector General, to be completed. There will be “no overlap” between the state and federal reviews, he said.

“We certainly didn’t want to be in their shop at the same time the IG’s folks are there,” Hoffer said.

The state review will not include contracts awarded by the state or money spent on the exchange, according to Hoffer.

“It’s not about contracts at this point. Some of that ground has been pretty heavily plowed,” he said. “Clearly, everybody knows and these reports have documented, that there have been a lot of problems.”

The state audit will involve two to three employees from the auditor’s office and is expected to take months to complete.

“These things are complicated and take a long time. I have yet to see an audit take less than four months — six is more likely,” Hoffer said. “It’s my intention to really encourage folks to find a way to get this done during the [legislative] session. That might involve trimming the objectives to save time.”

Racine out at AHS

MONTPELIER – Agency of Human Services Secretary Doug Racine is being replaced, the Shumlin administration announced Tuesday, as challenges within the agency mount.

According to Shumlin administration officials, current Health Commissioner Harry Chen will replace Racine on an interim basis while a permanent replacement is sought.

“I appreciate Doug’s hard work over three and a half years to help Vermont’s most vulnerable,” Shumlin said in a release.

Doug Racine

Doug Racine

Shumlin touted the agency’s move to a data-driven, results-based planning strategy and a revamped mental health system under Racine’s tenure.

But the agency has faced significant challenges, too. Vermont Health Connect, the state’s online health insurance marketplace that is overseen by the agency’s Department of Vermont Health Access, has struggled and remains hobbled. And The Department for Children and Families has faced scathing criticism following the recent deaths of several children, allegedly at the hands of caregivers.

“This has been a tough job, but now is the right time to start with new leadership to take the Agency of Human Services forward,” Shumlin said. “I appreciate Dr. Chen’s willingness to get us started on that challenge.”

Harry Chen

Harry Chen

Chen is expected to remain as Interim Secretary of AHS through the end of the year. Deputy Commissioner of Health Tracy Dolan will head the Health Department in his absence.

A full story will appear in Wednesday’s editions of the Herald and Times Argus.

Milne admits past health, legal troubles

MONTPELIER — Republican gubernatorial candidate Scott Milne revealed in a statement to reporters Thursday that he was arrested three times in college and suffered a stroke in 2006.

The arrests, two for driving under the influence of alcohol and one for possession marijuana and cocaine, all resulted in convictions. Milne said in a telephone interview Thursday that the cases were “settled as expeditiously as possible without spending money on counsel.”

“I don’t think about them on a daily basis, but my presumption is they are part of the public record,” he said.

In 2006, Milne suffered an ischemic stroke caused by a blood clot in his brain. He said he has made a full recovery, suffers “very little residual effect,” and has been cleared by doctors to campaign and serve as governor.

“Basically, I have a little bit of numbness on one side of my buddy and that really is about it,” Milne said.

He gave credit for his recovery to his daughter who he said sought immediate medical attention when the stroke occurred.

Milne, who has yet to formally launch his campaign, said he wanted the information about his past to be out in the open. He said facts about his past “might be important and relevant” to supporters.

Scott Milne

Scott Milne

“I think we wanted to get it out. If we started to campaign earlier we would have sent it out a lot earlier,” he said. “It was a consideration when I was weighing whether or not to run.”

Milne, in the statement sent to reporters, said “Vermonters have a right to a governor who is upfront and transparent.” He promised transparency about his personal life as well as the “economic challenges and crisis of affordability we face as a state.”

Another exchange deadline to be missed

MONTPELIER — Change of circumstance functionality expected to go live this weekend on Vermont Health Connect will not be deployed as testing continues, according to Department of Vermont Health Access Commissioner Mark Larson.

The state’s vendor, CGI, was supposed to have the change of circumstance function live on the health insurance exchange website by May 21 based on an amendment to the original contract. But the state reached an agreement on a revised work plan to extend the deadline to June 8. Now there is a new delay.

“We’re making very good progress on the development of the functionality and we’re close with automated change of circumstance functionality, but have made the decision that it’s not ready to go this weekend into the live environment,” Larson said Friday.

When deployed, the upgrade will allow thousands of Vermonters to edit personal information online if mistakes were made during registration, or if they experienced a life-changing event such as marriage. A backlog of 10,000 requests has amassed since the site launched in October.

“It’s important to us to make sure that the functionality, when it’s ready to go, is ready to serve Vermonters well. So, we’re going to continue our work until we feel like it’s ready to serve Vermonters, and focus on the quality and thoroughness of our work at this point,” Larson said.

Rep. Michael Fisher

Rep. Michael Fisher

The delays are frustrating lawmakers, including House Health Committee Chairman Michael Fisher, D-Lincoln.

“I think this is a really serious problem and I think it’s really an unacceptable situation that we’re in right now. Ten thousand households, many of whom may have small inconsequential changes, a change of address or something, but many of these Vermonters are worried that they’re not going to be able to get the care that they need,” Fisher said.

Continued issues and delays with the exchange site could damage future health care reform efforts, he said.

“I just know that there’s a lot of worry out there and a lot of frustration and I have been hearing a lot of it,” Fisher said. “It really does impact people’s view of our ability to move forward on health care reform.”

Meanwhile, the state is negotiating with a new vendor to help the state deal with the backlog in change of circumstance requests. The backlog increased by about 2,000 requests in the last month or so.

The contract, details of which remain confidential as negotiations continue, was expected to be signed by the end of Friday, Larson said. It will provide additional workers to help users update their information.

“It will help in the ability to have the automated functionality be able to assist in the work of resolving the backlog of change of circumstance requests. It will make it faster, but it will not eliminate the work left to do in making sure that we respond to all of those Vermonters who have made requests,” he said.

State officials expect users will still want assistance in changing information once the functionality is deployed.

“We fully expect that there will be a lot of people who will continue to want assistance in that process and we’ll be able to be more efficient with that,” he said. “It’s still going to take a significant effort to respond to everybody.”

Larson said he would not provide a specific date when testing will be completed and the system can be upgraded. “I think we are hopeful that we will be able to deploy this functionality soon. Again, we really have made a significant amount of progress,” he said.

neal.goswami@timesargus.com

Another exchange deadline missed, but state extends timeframe

MONTPELIER — A function missing from Vermont’s online health insurance marketplace will not be added by today’s deadline, but state officials say they are giving the contractor additional time to complete the project before they look to impose penalties.

Under an amended contract signed in early April, tech giant CGI was required to deliver “change of circumstance” functionality by today. The upgrade would allow thousands of Vermonters to edit their personal information online if mistakes are made during registration, or if they experience a life-changing event such as marriage.

But progress remains slow, and the function remains in testing, according to Mark Larson, commissioner of the Department of Vermont Health Access.

“We will not have the change of circumstances functionality tomorrow,” Larson said Tuesday.

Mark Larson

Mark Larson

Vermont Health Connect, the state’s online health insurance marketplace required under the federal Affordable Care Act, launched in October with serious deficiencies. Users are still unable to edit their information, and small businesses must enroll directly with the state’s insurers because the website is not functional for them.

The ability for individuals to make online payments for premiums was added in early March. Prior to that, payment had to be mailed in by check.

Larson said the “change of circumstance” upgrade has been postponed, likely until June, because it is not ready to be integrated into the website.

“We’re not going to implement any new functionality until we’re sure that it’s ready and fully tested,” he said.

“After careful consideration and reflecting on what we’ve learned over the past few months … I expect that we will agree to push the expected delivery date for change of circumstance to June 8,” Larson said. “I think that is a more realistic time frame for the functionality to be completed the way we would expect to.”

The state is allowing the use of a provision in the $84 million contract with CGI that allows for a change in deadlines if both parties agree. Larson said he expects the formal agreement to be signed today, setting the new June 8 deadline.

The state, by agreeing to a change in date, is also pushing back when it can begin to collect on the financial penalties it is allowed to assess for late delivery, according to the contract. Under the contract, the state can take a 12.5 percent discount on the cost of the function.

CGI can “earn” back some pay, however, depending on how quickly it completes each task after a missed deadline. Completion within seven days will allow for a 50 percent reduction in the penalty. Completion within 14 days will allow CGI to earn back 25 percent of the penalty, and completion within 28 days will allow for a 10 percent reduction in the penalty.

Those penalties will not be available until after June 8, if the agreement between the state and CGI is signed.

“By agreeing to a change in date we agree that those penalties will be applied if the delivery is not accomplished on June 8,” Larson said. “The penalties are all triggered by the agreed-upon date.”

Larson said June 8, “is more realistic” for upgrading the site and adding change of circumstance.

“Vermonters have the appropriate expectation that that function be available to them, and I know that Vermonters are frustrated by that not being there today,” he said. “I share that frustration and have a responsibility (to develop) a plan that is most likely to be successful and I think the change is consistent with that.”

Larson said the state will look to assess financial penalties if the new date is not met.

“I believe that the plan to achieve success is more likely with the change of date,” he said. “We aren’t eliminating any of our ability to impose financial penalties. We reserve all of those rights in the contract.”

The amended contract, signed in April, also requires CGI to deliver the small business enrollment function by July 2. No changes have been made to that deadline.

“We are still evaluating that. We’ve made no change there, though,” Larson said. “That date still stands, right now.”

A spokeswoman for CGI did not respond to phone and email messages Tuesday.

State, CGI sign amended contract with new timeline and penalties

MONTPELIER — State officials and the contractor building Vermont Health Connect have signed off on a new agreement that sets a new schedule for launching missing functions and includes additional financial penalties for missed deadlines.

The amended contract with tech giant CGI was signed Tuesday by Department of Vermont Health Access Commissioner Mark Larson and Gregg Mossburg, a senior vice president with the firm.

Under the amended contract, CGI must deliver “change of circumstance” functionality by May 21. By July 2, small business functionality must be operational. Failure to deliver by those dates will result in new financial penalties on top of the $5 million in “liquidated damages” the state has already claimed for CGI’s incomplete work.

“We really were trying to define an achievable road map and pair it with payment provisions and financial accountability so that we have an achievable plan and one that preserves for the state accountability for the success of that plan,” Larson said Thursday.

Lawrence Miller

Lawrence Miller

Vermont Health Connect, the state’s online health insurance marketplace required under the federal Affordable Care Act, launched last October with serious deficiencies. Users are still unable to edit their information, and small businesses must enroll directly with the state’s two insurers because the website is not functional for them. The ability to make online payments for premiums was finally added in early March.

Secretary of Commerce Lawrence Miller, tapped by Gov. Peter Shumlin in January to assist the beleaguered exchange team, said the previous contract with CGI “contemplated getting through development by October and everything being neat and clean.”

But late last year, after reviewing the state’s options, Miller and others began negotiating with CGI on a new contract that would help complete the project. Despite calls by Republicans to dump CGI, state officials determined that developing a new path with CGI was the best solution.

“There was this sort of fundamental question after December of do we finish the project with CGI or do we find somebody else. It was really clear, talking to other organizations and folks who have done this before, that the disruption of change, trying to change contractors, greatly exceeded the risk of negotiating a revised agreement and a revised path to done,” Miller said.

Massachusetts and the federal government have opted to drop CGI in favor of other tech firms. Other states are working with their contractors to redefine tasks and goals.

“When I’ve talked to people around the country, they are doing a combination of amendments to contracts and replacement of vendors. Everybody’s taking a slightly different approach. We did not consult with other states on the specifics of this,” Miller said.

Both sides “were pretty well firm on what was important to them,” according to Miller, but main components of the negotiated amendment “were not in substantial conflict.”

“Both parties wanted to finish the work and both parties recognized that this would be done in stages now,” he said.

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