Health system change trauma is affecting efforts by a National Association of Insurance Commissioners team to complete a supplement to health insurers’ annual report forms.
Blanks Working Group at the NAIC, Kansas City, Mo., is trying to help implement the new Affordable Care Act – the federal legislative package that includes the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act – by producing a new supplement and instructions for recording individual, small group and large group major medical health insurance business.
The supplement should help state insurance regulators implement ACA minimum loss ratio provisions that will require insurers to spend 85% of large group premiums and 80% of individual and small group premiums and medical care and quality improvement activities.
In a column for recording “health care quality improvement” expenses, for example, the working group has suggested that insurers should exclude costs related to complying with the shift to the ICD-10 system – a new system for classifying patient diagnoses and procedures.
Candy Gallagher, a vice president at America’s Health Insurance Plans, Washington, has blasted the decision to have insurers exclude ICD-10 conversion expenses from the quality improvement column.
The new ICD-10 requirement, which will take effect Oct. 1, 2013, “imposes costs on insurance companies that will be in the billions of dollars over the next 3 years,” Gallagher writes. “This represents an unusual spike in costs at a time when health plans struggle to find ways to keep health care premiums down and maintain low administrative expenses.”
Sarah Thomas, a vice president at the National Committee for Quality Assurance, Washington, a health plan quality measurement and accreditation group, has written to object to a decision to exclude accreditation fees from the quality column.
WellPoint Inc., Indianapolis (NYSE:WLP), sent a letter contending that the definition of health quality improvement expense is too narrow in many ways.
The individuals who have been chosen to represent consumers in NAIC proceedings blasted WellPoint for commenting so extensively on the health blank supplement draft.
“Representatives of consumer groups, insurers, and other interested parties have spent hours participating in these conference calls and many more hours drafting comments on the issues that have been addressed by these conference calls,” Timothy Jost writes on behalf of the consumer reps. “This laborious, transparent, participatory process has produced the document that you have before you today.”
Rather than commenting on the limited set of issues that are supposed to still be open for discussion, WellPoint is asking the NAIC’s Financial Condition Committee, the parent of the group developing the blank supplement, to “tear up and discard the entire work product of the subgroup, starting all over again with a fresh slate to define the activities covered” covered by the ACA minimum medical loss ratio provisions, Jost writes. “We urge this committee to adopt the carefully and conscientiously drafted blank and definitions crafted by the subgroup and to not at this late date reopen all of the issues it has resolved.”