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Health Law and Policy Update

Headlines of the week

Insurance commissioners approve preliminary proposal on medical loss ratio form
During a meeting in Seattle last week the National Association of Insurance Commissioners (NAIC) unanimously approved a document insurers will have to fill out to determine whether they are meeting medical loss ratio standards established under the Affordable Care Act. Medical loss ratio or MLR, refers to the percentage of dollars spent by health insurers on medical care and quality improvement activities versus the percentage spent on administrative costs.

Consumer advocates had argued for adhering to a proposal agreed upon by the NAIC working group charged with making recommendations to the commissioners. That set of proposed recommendations was adopted, with some modifications. Politico reports NAIC consumer advocate Timothy Jost, a professor of health policy at Washington and Lee University, said: "In general, we are very pleased. The process has been very open and participatory. We feel like our concerns have been listened to."

Outstanding issues remain, such as whether federal taxes are included in the MLR calculation.

NAIC adopts resolution on importance of role of insurance brokers
At the same meeting, NAIC adopted a resolution supporting the role of brokers and agents. The substantive portion of the resolution is as follows:

As the standards for implementing national health reform are being developed, it is essential that they recognize and protect the indispensable role that licensed insurance professionals play in serving consumers. It is important for federal policymakers to acknowledge the critical role of producers and to establish standards for the exchanges so that insurance professionals will continue to be adequately compensated for the services they provide, and so that the duties of Exchange Navigators appropriately reflect the important role of insurance producers who are skilled, knowledgeable, educated, and licensed and regulated.

The full resolution is available on the NAIC website.

NAIC's adoption of that position is a troubling development and signals the influence the industry has in the proceedings. The NAIC Health committee (B Committee) had already agreed to study the impact of exchanges and agent issues in depth.

Amendment 63 qualifies for Colorado ballot
Backers of a state ballot measure that takes aim at implementation of the Affordable Care Act collected enough valid petition signatures to qualify for a place on the Nov. 2 ballot, Colorado Secretary of State Bernie Buescher announced this week. The campaign opposing the measure, called Colorado Deserves Better, released a statement from Edie Sonn of the Colorado Medical Society:

Amendment 63 is costly, complicated, and it does not belong in the Colorado Constitution.

This constitutional amendment will lead to higher health care costs for insured individuals and businesses as they are forced to absorb the costs of the uninsured. In addition, Amendment 63 could incite a frenzy of lawsuits, costing taxpayers hundreds of thousands of dollars.

This constitutional amendment could result in a tangle of unintended legal and medical consequences, getting between Coloradans and their doctors and interfering in decisions about the type of healthcare that doctors can provide.

And it further clutters the state constitution: This constitutional amendment adds to the already-overburdened Colorado Constitution, and it will have consequences for decades to come.

Colorado deserves better, and we believe Colorado voters will say no to this expensive, complicated proposal.

Colorado Division of Insurance receives $1 million through ACA
Colorado's Division of Insurance was awarded $1 million through a provision of the Affordable Care Act. According to the Department of Health and Human Services press release, the grants were designed "to enhance states' current processes for reviewing health insurance premium increases" and to make health insurance markets more consumer-friendly and transparent. Colorado was one of 45 states to receive an award.

Colorado will use its award to:

  • Improve the review process: Colorado currently prospectively reviews all health insurance premium increases. The state will update its existing review and filing requirements to enhance the quality of its review process and comply with all new federal requirements. Contracted actuaries and rate analysts will be used to develop and implement the new process.
  • Increase transparency and accessibility: Currently, health insurance premium filings are not publicly available, but summaries are posted on the web. Colorado will make its website more consumer-friendly and will post complete premium increase filings. Additionally, the State will conduct web-based town hall meetings to educate consumers and will host public rate hearings.
  • Develop and upgrade technology: Colorado will upgrade its systems to improve efficiency and streamline data sharing.

A state-by-state summary of how the money will be used is available on the healthcare.gov website, and specific information about Colorado is available on the state's health care reform website.

CMS issues guidance on enhanced Medicaid funding provisions
President Barack Obama signed the Education, Jobs and Medicaid Assistance Act into law on Aug. 10. Among other things, the legislation extends the increased federal Medicaid matching rates (FMAP) under the American Recovery and Reinvestment Act (ARRA) through June 30, 2011.

As a condition of receiving those additional federal funds for the extension period of Jan. 1 to June 30, 2011, the chief executive officer of the state must submit a request for those funds by Sept. 24. Two of the requirements for receiving the enhanced Medicaid match rate included in a letter from Cindy Mann, director of the Center for Medicaid, CHIP and Survey and Certification (CMCS), are that:

The state shall not apply Medicaid eligibility standards, methodologies, and procedures that are more restrictive than those in effect under the state plan (or any waiver or demonstration project) on July 1, 2008, and

No amounts attributable (directly or indirectly) to such increased FMAP are deposited or credited to any reserve or rainy day fund of the state. (Section 5001(f)(3) of the Recovery Act).

Insurers promise complete care, regardless of restrictions at individual hospitals
Three major health insurance companies pledged this week to ensure employees of the City and County of Denver receive adequate care with respect to reproductive choice and planning, the treatment of gay and lesbian patients, and end-of-life issues. Questions about the availability of treatment in those areas came up during a meeting of a Denver City Council committee charged with overseeing employees' health insurance. Councilwoman Carol Boigon led the committee's consideration of the issue.

Denver Health, United Health Care and Kaiser Permanente assured the committee that city employees' needs would be met, and that if any hospital did not offer the treatment required, alternative facilities were being and would continue to be made available.

CCLP has been monitoring policies at hospitals that withhold specific treatments for religious reasons, including Denver-area hospitals that are part of the Exempla Healthcare chain. CCLP and others interested in requiring hospital disclosure will be meeting with State Chief Medical Officer Dr. Ned Calonge on Sept. 15.

What's new

New insurance finder web tool simplifies the process of searching for health coverage
The U.S. Department of Health and Human Services announced a new HealthCare.gov web tool available for download that makes searching for coverage options easier. HealthCare.gov allows consumers to search for public and private health coverage. Based on answers to a series of questions, the coverage finder produces a menu of coverage choices personalized for the user.

Health insurance exchanges: Comments on federal rulemaking due Oct. 4
The Department of Health and Human Services is seeking public comments on a section of the Affordable Care Act that regulates health insurance exchanges. The deadline for comments is Oct. 4.

Colorado Health Insurance Exchange Forum set for Monday
The next Health Insurance Exchange Forum is set for 3 to 5 p.m. Monday in the gymnasium at Craig Hospital. It is in the "Craig West" building, at 3425 S. Clarkson St. in Englewood. Guests should enter through the Craig West front door and follow the signs straight west through the first floor to the gym. Details are on the website of the Department of Health Care Policy and Financing.

CoverColorado seeks input on fee schedule
CoverColorado's board is in the process of establishing a fee schedule to apply to health care providers that serve CoverColorado members throughout the state. The schedule will prohibit balance billing by providers. By law, the schedule must be set at amounts that exceed the reimbursement generally paid to any category of provider by Medicare. As part of the process, the board is seeking input from providers, consumers and others on the best way to achieve needed savings in claims costs.

What you can do

Schedule a presentation on health reform
Health reform can be confusing. The health staff at the Colorado Center on Law and Policy is ready to help community groups, medical professionals, lawmakers and others understand the complexities of health reform and how it will roll out during the next few years. Please contact us to schedule a presentation.

Health Law and Policy Update is issued weekly by the health staff of the Colorado Center on Law and Policy. Subscribe by e-mail or read previous editions.

Health Care Director
Elisabeth Arenales

Health Care Attorney
Adela Flores-Brennan

Special Counsel
Ed Kahn

Communications Director
Perry Swanson

Released Aug. 28, 2010