Health Plan To Return to Local Control?

Tuesday is a big day for the Alameda Alliance for Health.

On Sept. 1, the not-for-profit local health plan in the East Bay officially begins its new claims system — the failure of which was one of the big factors in the takeover by the state in May 2014.  

Once the claims system goes live and proves workable, that’s the last of three major changes required by the Department of Managed Health Care for reinstatement of the Alliance to local control.

According to DMHC Director Shelley Rouillard, there still are a number of small outstanding requirements to be met, but she hopes full operations of the health plan can be turned back over to Alliance board and staff Oct. 29, the date of the next hearing to be held before a Superior Court judge.

“I’m optimistic it will be a success,” Rouillard said of the revamped claims process. “The conservator has done a great job. This is obviously a huge issue to turn this back over to the board.”

In May 2014 DMHC officials decided it had seen enough of the Alliance’s failing finances and late claims payments and they appointed an independent firm to act as conservator of the local health plan.

“We have developed a corrective action plan that describes the milestones the plan needs to meet,” Rouillard said.

Those milestones include establishing adequate tangible net equity, clearing the backlog of payment claims and setting up a new claims payment system. Those three requirements seem to be met, Rouillard said.

In addition, other goals include timely answering of phone calls and establishing accurate provider directories.

The past year has been a good one for Alameda Alliance, Rouillard said, with increases in enrollment numbers thanks in part to Medi-Cal expansion.

“The plan has increased its membership significantly and it’s been growing every month,” Rouillard said.

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