Close Close

Regulation and Compliance > State Regulation

PPACA rate reviews: Ideas for making them more open

Your article was successfully shared with the contacts you provided.

A group of state insurance regulators is considering ideas for making some states’ health insurance rate review programs more open to consumers.

The Consumer Liaison Committee, an arm of the National Association of Insurance Commissioners (NAIC), has posted a collection of ideas from Jesse Ellis O’Brien, Lynn Quincy and Debra Judy on its section of the NAIC’s website.

The Patient Protection and Affordable Care Act of 2010 requires the U.S. Department of Health and Human Services (HHS) to set minimum requirements for state rate change reasonableness reviews. In practice, HHS has ruled that states either have to review proposed rate increases that exceed a 10 percent cut-off or let HHS do the reviews.

See also: PPACA: CMS Sticks with 10% Rate Review Trigger

HHS requires states to post rate review summary information on a public HHS website. Other state review publication practices very. Some put a public file on the Web when an insurer files an initial rate change applications. Others post detailed information only after completing a review, and some post only the summaries.

The people who came up with ideas on the Consumer Liaison Committee site are consumer representatives, or individuals chosen to provide official representation for consumers’ interests in NAIC proceedings. They say some states still give consumers too little information about reviews.

To learn more about the reps’ ideas for rate review transparency standards, read on.

Guy saying, No!

1. The reps want to look at the possibility of keeping states from hiding some of the information given in rate change filings from the public.

Some states let insurers protect what the insurers classify as trade secrets when that information is included in a rate filing. Other states, such as California and Oregon, do not allow trade secrets redaction.

The reps say the NAIC should look at what the experience has been in California and Oregon and see whether there is any good evidence for or against trade secrets redaction.

See also: NAIC Consumer Reps Make Case For Market Analysis


2. The reps want states to post the full application information when the states receive the information, not after the rates have taken effect.

Having access to the complete filing when the rate proposal is filed would help consumers make better use of public review, public comment and public hearing options, the reps say. 

See also: Consumer rep: The health rate windows are blurry

Highway to the future

3. The reps want to get ideas about how to take market innovations, such as narrower provider networks, into account when reviewing rates.

The reps want the NAIC to get experts to weigh in, so rate reviewers across the country will have better tools.

See also: Larsen: PPACA Rate Review Rules Work