“Closing the Loop” Helping Districts Understand and Implement Codified Best Practices in Public School Health Plans

All districts must  Comply with statute  Ohio Revised Code  Section  Comply with rules  Ohio Administrative Code  Sections through

Closing the Loop  Understanding what your district has to do  Understanding when your district has to do it  Might want a translator...

Legalese  “All health care benefits  provided to persons employed by the school districts of this state  shall be provided by health care plans  that contain best practices established pursuant to this section by the school employees health care board.”

Translation  Districts must offer health plans that contain the four best practice standards adopted by SEHCB.

Legalese  “Twelve months after the release of best practices by the board  all policies or contracts for health care benefits provided to public school district employees  that are issued or renewed after the expiration of any applicable collective bargaining agreement  must contain best practices established pursuant to this section by the board.”

Translation  All policies or contracts for healthcare benefits which are  issued or renewed  after January 1, 2010  at the expiration of a collective bargaining agreement  must contain the best practice standards.

Legalese  “ Each health care plan sponsor  offering health care benefits  to persons employed with the public school districts of this state shall  furnish to the board evidence of its compliance with all best practices as established by this chapter. ”

Translation  Districts must provide the SEHCB with evidence that health plans offered contain each of the best practice standards.

Legalese  “Each public school district shall file annually  on or before the first day of July  a written report, on a form prescribed by the board, which describes  the progress made to reduce the rate of increase in insurance premiums and employee out of pocket expenses and  the progress made to improve the health status of public school district employees and their allowable dependents.  The report shall also document the implementation of the best practice standards adopted by the public school district.”

Translation  Districts must file an annual written report  On or before July 1, 2010  Describing efforts taken to  Reduce rate of premium increases  Reduce employee out of pocket expenses  Improve health status of employees and dependents  Implementation of best practices

SEHCB Responsibilities  Also set by statute or rule  Certify compliance  Review the annual status report received from each public school district  Prepare and disseminate an annual report to the public  Work with health plan sponsors through educational outlets and consultation

SEHCB Annual Report  The board shall prepare and disseminate to the public an annual report on:  the status of each health plan sponsors’ effectiveness in reducing the rate of increase in insurance premiums and employee out of pocket expenses and  the progress made to improve the health status of public school district employees and their allowable dependents.

Outstanding questions  Work in progress  Ambiguity  Nature and extent of review of plans and programs  Appropriateness of ‘bright line’ definitions to resolve ambiguities, establish uniformity regardless of district size or other factors  Information to be included in SEHCB annual report  Lots of other things...

The point  Collaborative process  Shared goals  Open, regular communication  Transparency  Common sense can and will prevail