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Life Health > Health Insurance > Health Insurance

PPACA: Feds Short on Multi-State Plan Answers

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Officials at the U.S. Office of Personnel Management (OPM) may have raised more questions than they answered in a document aimed at entities wanting to participate in the new health insurance exchange multi-state plan program.

But if health insurer executives or others do have questions, then, apparently, that’s just too bad: OPM officials note in the first of 22 answers to questions about the multi-state plan program that they warned in June, when they put out the original request for information (RFI) for the program, that the only way to ask questions would be to submit questions in writing by 3 p.m. EST June 30.

“We have not scheduled an open call for potential respondents to this RFI,” officials say.

But OPM officials add that the RFI is not a request for proposals and will not be a formal part of the bidding process.

The drafters of the Patient Protection and Affordable Care Act of 2010 (PPACA) created the multi-state plan program to increase the overall level of competition in the health insurance market.

If PPACA takes effect as drafters hope and works as drafters expect, individuals and small employers will be able to use a new system of tax credits to buy health coverage through a new system of health insurance exchanges starting in 2014. Each exchange is supposed to make at least one slot available to a nonprofit multi-state plan and a second slot available to another multistate plan.

PPACA Section 1334 requires OPM to award the contracts needed to get the plans up and running by 2014.

The opportunity could be a large one: OPM officials say in one RFI question they do answer that the Congressional Budget Office has estimated that 9 million non-elderly individuals could be obtaining coverage through exchanges in 2014, and that the number could rise to 23 million by 2017.

But federal officials also had estimated that a PPACA program already created, the Pre-existing Condition Insurance Plan program (PCIP), could attract hundreds of thousands of enrollees and shut hundreds of thousands of other applicants out due to lack of funding. In April, about half a year after PCIP administrators started taking applications, the program had fewer than 25,000 enrollees.

OPM officials are assuring health insurers that they need not respond to the multi-state plan RFI if they would prefer not.

“You are not required to respond to the RFI,” OPM officials say in their answer about whether the RFI process is mandatory. “We appreciate any responses and input that you are interested in providing.”

Advisors can submit RFI responses on behalf of anonymous clients, including commercial insurers, and the responses will not be released to the public, officials say.

OPM officials answer some questions by simply quoting relevant sections of PPACA, without saying what they think the sections mean.

One question is, “Does the above-referenced RFI include dental?”

The OPM answer is, “In accordance with Section 1334(c)(1)(A) of the Affordable Care Act, a multi-state plan must offer a benefits package that is uniform in each state and consists of the essential health benefits described in Section 1302 of the Affordable Care Act. Section 1302 defines essential health benefits to ‘include at least the following general categories and the items and services covered within the categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.’ The essential health benefits will be the subject of future rulemaking by the Department of Health and Human Services (HHS).”

In the RFI, OPM notes that, if a state requires an extra benefit not included in the essential health

benefits package, the state is supposed to defray the cost of offering that benefit.

“It would be helpful to understand how the OPM views this working,” a questioner told the agency.

“This will be subject to future rulemaking by HHS,” OPM says. “For purposes of the RFI, respondents are encouraged to identify issues such as this and make appropriate suggestions.”

Some questioners asked about matters such as the breakdown in each state for male, female and age group, and for a copy of the loss runs.

“Multi-state plans have not yet been offered, so OPM does not have any of this data available,” OPM says.

OPM does suggest that HHS, OPM and the exchanges might play a role in publicizing the multi-state plans.-

Other health insurance exchange coverage from National Underwriter Life & Health:


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