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May 30, 2012 at 10:01 AM
The Blue Cross and Blue Shield Association (BCBSA) told an NAIC Exchanges subgroup that it agrees with its proposal to separate marketing and consumer information into two distinct sections but strongly advised that the NAIC not go further than the health care reform act requires.
The final rule from the Centers for Medicare and Medicaid Services (CMS) defers to existing state laws, the BCBSA told the NAIC Exchanges Subgroup’s Marketing and Consumer Information Team.
“We caution against [the NAIC] applying the Medicare Advantage rules for marketing in the exchanges because the states will play a considerable role in overseeing exchanges,” the BCBSA said in its comment letter May 24 to a draft paper on marketing and consumer information.
The letter was issued in advance of a team conference call May 31.
CMS does not provide specific criteria for marketing requirements under federally facilitated Exchanges and the Patient Protection and Affordable Care Act (PPACA) doesn’t require states to apply the same marketing requirement outside an exchange even if a state elects to establish new standards for exchanges, noted the letter, signed by David Korsh, BCBSA director of state services.
The letter revealed that it is unclear to the industry what the NAIC’s need was in the purpose and scope of its white paper on marketing and consumer information.
The white paper should clearly state up front that its purpose is to identify insurance department best practices to state oversight and compliance in those area with the PPACA, the letter said.
The draft paper states that its purpose is to explore issues and options for implementation of certain provisions of the law and regulations having to do with navigators, agents and brokers, summary of benefits and coverage and marketing……”Where possible, this paper will highlight these situations and possible differences in approach, including issues that implicate the involvement of the Departments of Insurance,” the draft states.
Moreover, the summary of benefits and coverage in the white paper should be under “consumer Information,” not in a separate section, the letter said.
The letter went on to stress that it believes the Navigator role in the Exchanges should be a regulated entity or person overseen by state insurance departments,and not a physician, a provider wit ha contractual interest or anyone else wit ha conflict of interest. PPACA already precludes health insurers from being Navigators.
PPACA and its regulations state that the Exchange must select entities from at least two of a cluster of categories (including a commercial fishing industry organizations, ranching and farming organizations) to serve as Navigators; and one of the two must be a community and consumer focused nonprofit group.
Navigator candidates need to be carefully screened and selected to ensure that they have the necessary capacity and connections to the targeted communities, stated the NAIC Consumer Liaison Representatives in a comment section to the NAIC draft white paper.
