Managed Care Background Morphs Into Obamacare

, The Connecticut Law Tribune


Virginia Lamb
Virginia Lamb

For her ability to supervise the handling of all legal issues that might arise in the operation of the exchange, Counihan said, "Virginia is highly valued."

Though her managed care experience allowed her to largely hit the ground running, there were, of course, differences between her former jobs and her new role. For instance, as a quasi-public agency established by the legislature to satisfy legal requirements of the federal Affordable Care Act, the health care exchange must adhere to public records and open meetings laws. That means the exchange has to hold public meetings and give proper notice of those meetings. The minutes must be recorded, and posted on the exchange's website. "Our office has hired a chief compliance officer," Lamb said.

Access Health CT employees spent much of this past summer getting organized, Lamb said. While outreach workers handed out flyers and health care literature at state beaches, county fairs and concerts, Lamb and her legal team helped make sure the nearly $15 million in federal money allotted for outreach and educational programs was properly spent.

Among the more summer's more complicated tasks was working to revise the exchange's ethics policy, bringing it in line with state law. For example, a restriction was added to all employment contracts that no employee of the exchange could serve as a consultant to a trade association, insurance company or health care provider. "We had to bring everything up to date," Lamb said.

Enforcing The Mandate

Although the Connecticut exchange is for people who don't have insurance or who want to change their health plans opened on October 1, businesses have until January 2015 to give reasonably priced health insurance to employees or risk fines.

The Affordable Care Act provision for companies, known as the "employer mandate" applies to businesses with at least 50 full-time employees, including full-time equivalent workers.

When the deadline kicks in, Lamb anticipates her office will be busy ensuring the mandate is followed by employers. State officials could possibly get involved working with the state Attorney General's Office to initiate legal actions if it's not. When it comes to interpreting the law, Lamb's office has backup in the form of the federal Center for Consumer Information and Insurance Oversight.

"They triage difficult questions, when we are not comfortable that we have clear direction from federal regulations or published guidelines," Lamb said.

Another future part of her job will be defending the Connecticut registry when it denies requests for coverage. Those who are rejected, for reasons ranging from income levels to place of legal residency questions, can appeal to an administrative law judge.

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