The U.S. Department of Health and Human Services (HHS) has given policy watchers in the health insurance community 324 new pages of reading: a batch of proposed Patient Protection and Affordable Care Act (PPACA) regulations that could affect the commercial health insurance market in 2016.
The draft regulations — the HHS Notice of Benefit and Payment Parameters for 2016 — would affect everything from how the PPACA “three R’s” risk-management programs work for all commercial health insurers, the user fees for insurers that sell coverage through the HHS-run PPACA exchanges, network adequacy rules, and how rate review programs will work.
Regulatory analysts may be finding gems in the text for months
HHS is set to post the draft in the Federal Register Wednesday, and comments will be due 30 days after the official publication date.
For a look at some of the interesting parts we found, read on.
1. Web brokers who sell qualified health plans (QHPs) for the HHS-run PPACA exchanges might have to provide access to oral interpretation services for 150 languages.
HHS officials say they were told telephonic oral translation services are readily available, but they said they are open to hearing about alternatives.
Officials said, for example, that it wants to hear what people think about “requiring written translations in the languages spoken by the applicable state’s top ten limited English proficiency (LEP) groups or spoken by 10,000 persons or greater, whichever yields the greater number of languages.”
Another approach could be requiring short statements, written in 30 languages, informing people about the existence of translation services.
2. The 150-language translation requirement could take effect as early as 2016, but HHS would consider imposing it later.
Officials said any people or entities affected by translation requirements, including the Web brokers that could be affected by the 150-language translation service requirement, might be able to meet the requirement by referring consumers to the exchange call center.
3. HHS wants to get help from outside vendors with verifying the credentials of the agents and brokers who work with the HHS-run exchanges.
Vendors have already been providing training, help desk and technical support for HHS exchange producers.
4. HHS is starting to develop a separate set of standards for the producer credential verification vendors.
Elsewhere, HHS says it assumes that all of the vendors who bid for the verification program and lose will file appeals.
5. The temporary PPACA reinsurance program minimum attachment point, or deductible, could rise to $90,000, from $70,000 in 2015 and $45,000 this year.
The program protects issuers of PPACA-compliant individual coverage against the risks of catastrophic claims.
The per-person fee used to fund the program would be $27 per insurance plan enrollee.
This one doesn’t mention agents and brokers directly, but the reinsurance fee will affect most of your customers, and the increase in the attachment point may increase the odds the insurers will find creative, subtle ways to discourage you from sending them consumers with obvious health problems.