The National Association of Specialty Health Organizations (NASHO) is asking state regulators to think about vision plans, behavioral health plans, physical therapists, chiropractors, and other types of specialty providers and specialty plans when they are setting up health insurance exchanges.
Julian Roberts, executive director of NASHO, Louisville, Ky., has written about the role NASHO member organizations might play in an exchange system in a comment submitted to the Exchanges Subgroup at the National Association of Insurance Commissioners (NAIC), Kansas City, Mo.
The subgroup recently posted draft documents discussing the health insurance exchange program that could be created by the Patient Protection and Affordable Care Act (PPACA).
“NASHO would like to make sure that consumers will still be able to access specialty care through the state exchanges,” Roberts writes in the comment letter.
PPACA does provide for stand-alone dental plans to be available through the exchanges, but NAIC officials appear to be aware that PPACA does not talk about how other specialty plans could be sold through the exchanges, Roberts says.
“There may need to be ‘sub-exchanges’ created in each state that will be connected to the comprehensive health exchange,” Roberts says. “It is our belief that making all of these options available within a single, or at least related, transaction point will be important to consumers as they look for specialty health options that may not be part of their comprehensive plans.”
THE EXCHANGE SYSTEM
PPACA is supposed to bring an exchange system to life in 2014.
Republicans and some Democrats are trying to block implementation of parts or all of PPACA.
If the health insurance exchange provision and related provisions take effect as written, PPACA will create a new health insurance purchase tax subsidy program in 2014. Consumers and small
groups will be able to use the subsidies to buy health coverage through the exchanges.
An exchange is supposed to help consumers and small groups shop for high-quality health coverage. In some states, states or exchange managers could set standards for coverage “qualified” to be sold through an exchange that might be tougher than the state or federal minimums.
THE NASHO VISION
NASHO has prepared a commentary suggesting that states ought to create an electronically linked specialty health organization exchange, so that specialty health organizations can continue to compete.
“Consumers purchasing qualified health plans are not likely to search multiple sites and directories to locate specialty services – but, if offered the option to browse specialty health plans while selecting a plan on the exchange, they may elect to purchase these services as an important adjunct to their qualified plan,” NASHO says.