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New York Sets Emergency Rules for Health Insurers

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New York state is trying to protect its current health coverage rules, and its Affordable Care Act public exchange program, against efforts by the Trump administration and Congress to change the ACA.

Related: GOP’s Heller Opposes Senate Health Plan in Blow to McConnell)

New York state Gov. Andrew Cuomo, a Democrat, put out a press release announcing a new set of draft emergency health market regulations earlier this month.

One provision could require insurers that want to participate in the state’s Medicaid program or Children’s Health Insurance Program to continue to sell coverage through its ACA exchange.

Another provision would require insurers to continue to cover the 10 categories of benefits now in the standard ACA essential health benefits package. Insurers would have to cover maternity and newborn care as well as abortion, pediatric services, mental health and substance use disorder services and emergency care, among other services.

The regulations would also prohibit discrimination in the issuance or rating of health insurance due to race, color, national origin, sex or disability.

The State Department of Financial Services published the draft in the State Register last week. The draft is subject to a 45-day public comment period.

In the draft, officials point directly to the ACA discussions in Washington as a reason to adopt emergency regulations.

“For the public health and general welfare, the department is promulgating this rule on an emergency basis in the event that Congress repeals the ACA,” department officials said.

Medicaid and NY State of Health

New York operates a state-based public exchange program, NY State of Health.

The state has about 242,000 people in private plans sold through the exchange system; 665,000 in Essential Plans, or standardized plans provided by private insurers but set up by the state; and about 6 million in Medicaid and CHIP coverage, according to exchange and federal data.

Cuomo has ordered the state’s Department of Health to bar any company that withdraws from the exchange from participating in the state’s Medicaid, CHIP or Essential Plan programs, in an effort to thwart insurers from leaving the state’s exchange program.

Some hospital and physician groups, including the Greater New York Hospital Association, applauded that directive and others.

Paul Macielak, the president of the New York Health Plan Association, said his group, which represents 29 managed care plans, believes most of the coverage requirements already exist in current laws or regulations.

“We do not understand the ‘emergency’ here” Macielak said.

Macielak also questioned the legality and timing of the directive requiring insurers that want to participate in Medicaid and CHIP to stay in the exchange program.

“In many ways, the governor’s press release has the potential to create more uncertainty for plans than the uncertainty of the proposals being discussed in Washington,” Macielak said.

In related news, the New York Department of Financial Services is reviewing health insurers’ rate filings for 2018. The department asked insurers to provide estimates showing how the elimination of major ACA commercial health insurance requirements and subsidies might affect their rates.

Health insurance companies in New York are asking for an average rate increase of 16.6% for individual coverage in 2018. That’s lower than the 19.3% average increase for 2017 coverage.

Insurers that tried to estimate how full repeal of the Affordable Care Act individual coverage mandate would affect their prices predicted full repeal would increase their rates by an additional 32.6%, department officials said.

— Check out New York Fines Excellus $1M Over Birth Control Claim Denials on ThinkAdvisor.


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