Au­dit: State’s Oba­macare ex­change makes progress

The Denver Post - - NEWS - By John In­gold John In­gold: 303-954-1068, jin­gold@den­ver­ or twit­

Colorado’s health in­sur­ance ex­change has made progress in ad­dress­ing re­peated ac­count­ing trou­bles but still fails to al­ways fol­low its own poli­cies when it comes to con­tracts and pur­chases, ac­cord­ing to a state au­dit re­leased Tues­day.

The au­dit of the ex­change, known as Con­nect for Health Colorado, found that 11 per­cent of pay­ments an­a­lyzed — which came out to about $50,000 — did not have the proper doc­u­men­ta­tion. The same was true for nearly $4 mil­lion in con­tract costs. In one in­stance, the au­dit found that Con­nect for Health’s gen­eral coun­sel signed off on a nearly $3 mil­lion data­base con­tract de­spite not hav­ing the au­thor­ity to do so for con­tracts that big.

“These prob­lems hap­pened be­cause Con­nect for Health did not al­ways fol­low its poli­cies or up­date its poli­cies to re­flect cur­rent prac­tices,” Car­leen Arm­strong, a team leader at the Of­fice of the State Au­di­tor who worked on the new au­dit, said at a Tues­day morn­ing meet­ing where the re­port was pre­sented to law­mak­ers.

Con­nect for Health CEO Kevin Pat­ter­son largely agreed with the find­ings, say­ing the ex­change is con­tin­u­ing to im­prove its ac­count­ing prac­tices. He also said the ex­change is work­ing to im­prove its process for field­ing and re­spond­ing to com­plaints — an­other area where state au­di­tors dinged the pro­gram.

“We ex­pect to have all these things cleaned up and ap­pro­pri­ately change by fall this year,” Pat­ter­son said at Tues­day’s meet­ing.

Con­nect for Health is the place where peo­ple in Colorado who buy health in­sur­ance on their own can shop for plans, and it is the only place where peo­ple in Colorado can buy health plans that are el­i­gi­ble for tax cred­its through the Af­ford­able Care Act, also known as Oba­macare. Colorado is one of 11 states that op­er­ates its own ACA ex­change. All other states use the fed­er­ally op­er­ated Health­

The new au­dit fol­lows up on one from 2014 and a fed­eral au­dit from ear­lier this year, both of which found that Con­nect for Health ei­ther didn’t ap­pro­pri­ately doc­u­ment or mis­spent mil­lions of dol­lars. Rel­a­tive to those re­ports, then, Tues­day’s au­dit was mostly pos­i­tive for the ex­change.

The au­dit found that Con­nect for Health has taken steps to in­crease its rev­enues and con­trol costs — in­clud­ing a sav­ings of $18.5 mil­lion that came through ad­min­is­tra­tive cuts and con­tract rene­go­ti­a­tions. The au­di­tors project that Con­nect for Health will be fi­nan­cially sus­tain­able through at least the 2019 fis­cal year, pro­vided there are no ma­jor changes to the Af­ford­able Care Act.

“I re­ally want to say con­grat­u­la­tions,” state Rep. Tracy KraftTharp, an Ar­vada Demo­crat who is the chair of the leg­isla­tive au­dit com­mit­tee, said to Pat­ter­son at Tues­day’s meet­ing. “You’ve re­ally made some gi­ant steps these last cou­ple of years.”

But the au­dit warned that con­tin­ued fail­ure to tighten up its book­keep­ing and ad­here to its poli­cies could threaten the ex­change’s vi­a­bil­ity. The au­dit notes that Congress is cur­rently de­bat­ing pro­pos­als to re­peal or re­vise the Af­ford­able Care Act, which would have ma­jor im­pli­ca­tions for the ex­change’s fi­nan­cial health.

“Given that Con­nect for Health’s fu­ture rev­enue growth may be lim­ited or de­cline, it is im­por­tant that it have fi­nan­cial con­trols that are work­ing as in­tended to en­sure that all of its ex­penses are rea­son­able and nec­es­sary,” the au­dit states.

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