The federal government, through the U.S. Department of Health and Human Services (HHS), will probably be running health care exchanges in many states, said Sandy Praeger, Kansas Insurance Commissioner and head of the Health Care and Managed Care (B) Committee of the NAIC in an interview after the HHS released its interim final exchange rules Monday.
“Each one is going to have a different flavor,” “she said about the various state exchanges. ”We all get to establish our own essential health care benefits,” for instance, she said.
Praeger, a past president of the NAIC, said she still sees opportunities for states to perform many functions for HHS, especially including the rate and form review and network adequacy functions, and cited the SERFF system as a tool.
SERFF, the System for Electronic Rate and Form Filing, is an NAIC business arm and program that offers a technological solution to for both the filing and approval process.
“I really think HHS will use our SERFF system,” Praeger said. “The more they learn about it, the more they realize they don’t have to ‘reinvent the wheel.’”
According to SERFF’s website, 49 states, the District of Columbia, Puerto Rico and over 3,400 insurance companies and others use SERFF. In 2010, the system recorded more than half a million filings and generated $4.2 million, or 5% of NAIC revenue.
The NAIC is developing guidance for how states might approach the areas in which they can play a role, with proposals and white papers, and hope to get that done before the August Summer meeting, via the Exchanges (B) Subgroup, Praeger said.
The NAIC has a white paper, Financing the Exchange.
Praeger mentioned that there could be some sort of memo of understanding between the federal government and the states with regard to integrating the SERFF system within the exchanges. Doing so could save money for the government and for insurance companies, which would not need to make duplicative rate and form filings, she said, adding that the exchanges do know it will be a “heavy lift,” but that the insurance companies would be gaining “a whole lot more customers.”
Some states that got rate review grants were able to give a portion of that grant to NAIC and SERFF personnel in order to get some of that technology integrated, Praeger noted.
By Oct. 1, 2013, states are required to have formed new organizations to operate the exchanges, including hiring and training staff, and implementing business processes and IT systems. The exchanges must be operational by Jan. 1, 2014.