PPACA Toolbox (AP Photo/Jacquelyn Martin)

Interest groups are trying to get their ideas into a document that could affect how state insurance regulators implement the Patient Protection and Affordable Care Act of 2010 (PPACA).

The groups are commenting on a draft of a form review white paper now being developed by a team at the Exchanges Subgroup at the National Association of Insurance Commissioners (NAIC), Kansas City, Mo.

The list of commenters include groups that often comment on Exchanges Subgroup proceedings, such as America’s Health Insurance Plans (AHIP), Washington, and the Blue Cross and Blue Shield Association, Chicago.

The list also includes groups that are less involved with the NAIC, such as the Leadership Conference on Civil and Human Rights, Washington, and a coalition of groups with an interest in reproductive law.

The form review team says in the draft that it is developing the paper to help state policymakers implement PPACA provisions that affect certification of “qualified health plans” and reviews of the QHPs’ enrollment forms and other forms.

PPACA calls for states to set up a new system of health insurance exchanges, or Web-based health insurance supermarkets. The QHPs would be the plans that could sell coverage through the exchanges.

Individuals and small groups could use new federal health insurance tax subsidies to buy coverage through the exchanges. Other individuals also could buy coverage through the exchange system.

Candy Gallaher, a senior vice president at AHIP, emphasizes process efficiency in the AHIP comment.

White paper drafters talk about using the existing state form review system –  the System for Electronic Rate and Form Filing (SERFF) — to handle the QHP form reviews.

That might be a good approach, but regulators ought to look at how the changes would work in practice and whether a state really can implement the required changes through SERFF, Gallaher says.

Gallaher says she is glad to see white paper drafters acknowledging that PPACA will lead to “an intense period of increased number of filings and new changes.”

“Your recommendations for tools to streamline the process, including training for industry filers and state form review and actuarial staff is very prudent,” Gallher says.

Joan Gardner, a state services specialist at the Blue Cross and Blue Shield Association, says she worries about the white paper giving regulators the impression that some PPACA rules that apply only to QHPs sold through a PPACA exchange also apply to other plans.

In one area, for example, the draft implies incorrectly that PPACA grace period rules for QHPs also apply to other types of plans, Gardner says.

Wade Henderson, president of the Leadership Conference, and other conference leaders want the final version of the white paper to emphasize that QHPs must follow federal anti-discrimination rules because they are getting federal funds.

The conference has added “Age, Disability” to the section heading “Non-Discrimination of participants and their beneficiaries based on Race, Ethnicity, Nationality, Gender, Sexual Orientation, Genetic Information and Religion.”

The text under the heading should state that members of the protected classes of people cannot be excluded from any health program or activity “any part of which is receiving Federal financial assistance, including credits, subsidies, or contracts of insurance,” the conference says.

The conference also wants the white paper to state that, “Issuers of QHPs are covered under [Section 1557 of PPACA] and other federal civil rights laws because they will receive insurance premium payments through federal premium credits, a form of federal financial assistance.”

The reproductive law coalition — a group led by the National Women’s Law Center, Washington, and the National Partnership for Women & Families, Washington — wants the white paper team revise a draft section on “Abortion Services and Separation of Funds.”

PPACA Section 1303 requires a QHP that covers abortions to collect separate amounts for the abortion services benefits.

A QHP can satisfy the requirement if it provides an itemized bill that separates the costs of abortion coverage from the costs of all other coverage, collects the required separate payments through a single transfer of funds in response to the itemized bill, and maintains “allocation accounts,” the coalition says.

The law only requires a QHP to collect separate payments from individuals receiving premium assistance credit, the coalition says.

“Therefore,” the coalition says, “the segregation requirements may be satisfied by applying it only to these individuals.”

The coalition wants the white paper to emphasize the distinction by including a passage stating that, “A QHP issuer must collect separate payments only from individuals receiving premium assistance credit; therefore, the segregation requirements apply only to these individuals.”