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November 18, 2014 at 01:38 PM
State health insurance regulators have been pondering the effects of the November elections this week at the fall meeting of the National Association of Insurance Commissioners (NAIC).
The NAIC’s Health Insurance and Managed Care Committee and its units have been focusing heavily on implementing the Patient Protection and Affordable Care Act (PPACA) since President Obama signed the act into law in 2010.
Now both chambers of Congress and a majority of state governorships are in the hands of Republicans who either oppose the PPACA provisions that affect commercial health insurance or have mixed feelings about those provisions.
While at the NAIC fall meeting, in Washington, D.C., regulators have also been going about the everyday business of reviewing and updating old regulations.
See also: 5 battles over the PPACA-free zone
The NAIC cannot set state laws or regulations directly, but it often shapes what state policymakers do, and agents and brokers who ignore it may find the world around them going through inexplicable changes.
For more on what health insurance regulators have been up to in Washington, read on.
1. The Health Insurance and Managed Care Committee approved drafts of the Individual Health Insurance Coverage Model Regulation and the Small Group Market Health Insurance Coverage Model Regulation.
The models would be companions to the Individual Market Health Insurance Coverage Model Act and the Small Group Health Insurance Coverage Model Act. The model regulations could affect matters such as which companies are classified as health insurance issuers and when patients can get out of having to pay the full out-of-network price for out-of-network care.
Image: President Obama signs the bill that created PPACA. (AP photo/J. Scott Applewhite)
2. Regulators spent a lot of time thinking about health plan provider networks.
Sabrina Corlette and Sally McCarty of the Center on Health Insurance Reforms, an arm of Georgetown University, presented a major report on a topic of great interest — determining when a health plan’s provider network is big enough. The speakers encouraged regulators to try using the network adequacy planning tool at http://www.statenetwork.org to see if actual plan networks are adequate.
Stephanie Mohl of the American Heart Association (AHA) presented a report for consumer representatives on how states now handle network adequacy regulation.
The NAIC already has a network adequacy model act, but few states have adopted it either in whole or in part, and states use a variety of different, conflicting codes to track patients’ network adequacy complaints, Mohl said.
State regulators told the consumer reps that their biggest network-related challenge is ensuring that consumers understand the cost of getting care out-of-network.
Fewer than the half of the states have transparency requirements for out-of-network doctors who are providing care for a patient who is in an in-network hospital.
