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Legislative Update: Key Developments in Health Care and MLR – August 10, 2011

This legislative update highlights critical developments concerning Minimum Loss Ratio (MLR) regulations, state waiver approvals, and exchanges in the health care landscape as of August 10, 2011. Key updates include the growing support for H.R. 1206, approval of additional state waivers for MLR, and advancements in state-level exchange actions. Notably, Iowa and Kentucky received approval, while North Dakota and Guam were denied. This update also discusses the finalization of the Federal Pre-existing Condition Insurance Plan (PCIP) broker registration process.

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Legislative Update: Key Developments in Health Care and MLR – August 10, 2011

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  1. Legislative Update August 10, 2011 Kristin Leighty, Government Affairs Coordinator, NAHU

  2. NAHU Government Affairs team Laurel Call, Sr. Vice President and Counsel – Regions 6 & 8 lcall@nahu.org 703.276.3801 Jessica Waltman, Sr. VP of Government Affairs – Region 2 jwaltman@nahu.org 703.276.3817 Pam Mitroff, Director of State Affairs – Illinois, West Virginia, Regions 4 & 7 pmitroff@nahu.org 703.276.3839 Brooke Bell, Director of State Affairs – Region 1, 3 & 5 bbell@nahu.org 703.276.3818 Kristin Leighty, Government Affairs Coordinator kleighty@nahu.org 703.276.3803

  3. MLR and H.R. 1206 • Co-sponsor total sits at 113! • Keep the pressure on while members of Congress are in their home districts! • Sen. Mary Landrieu (D-LA) Sends Letter to HHS • Letter highlights MLR’s negative impact on agents and brokers and includes a direct ask to delay the inclusion of agent compensation in the MLR calculation • Signifies a huge step highlighting the increasing awareness of this issue in the Senate • NCOIL votes unanimously to endorse 1206! • Looking ahead…

  4. Status of MLR State Waivers • HHS Recently Approves Two More State MLR Waivers • Iowa and Kentucky join the ranks of approved states • North Dakota Becomes First State to be Denied Waiver • Territory of Guam receives denial letter as well • Texas and Michigan Become Next States to Apply • TX asks for graduated increase of 71% in 2011, 74% in 2012, 77% in 2013 and 80% in 2014 • MI asks for 65% in 2011, 70% in 2012, 75% in 2013 and 80% in 2014 • Scoreboard: • Approved: ME, NH, KY, NV, IA • Denied: ND • Pending Applications: DE, FL, GA, IN, KS, LA, TX and MI

  5. Exchange Developments • Exchange Guidance Finally Released! • July 11 the highly anticipated proposed regulations were released • NAHU Staff and Exchange Working Group continues to analyze the regulations • NAHU has prepared a chart highlighting provisions impacting agents/brokers • Proposed rules will undergo a 75 day comment period • Other Pending State Exchange Action • While legislatures are out of session many governing boards and exploratory committees continue to meet and make progress on state exchange action • NAHU state affairs staff continues to work closely with states to steer them in the right direction • Kansas returns early innovator exchange grant funds to HHS • Scoreboard: • Signed-13 (CA, CO, CT, HI, IL, MD, ND, NV, OR, VA, VT, WA, WV • On Hold-9 (DC, ME, MN, NE, NC, NH, NY, PA, TX) • Dead/Vetoed-11 (AK, AZ, AR, IN, MO, MT, NE, NM, OK, RI, SC) • Work Arounds-8 (AL, GA, IN, IA, KS, MS, OH, WI) • Joel Ario (HHS) stepping down

  6. PCIP’s Broker Registration Process Opened • Federal Pre-existing Condition Ins Plan (PCIP) has now finalized its online registration process for agents/brokers • In May, the administration announced it would begin compensating agents and brokers for connecting eligible people with the PCIP program by October 1 • Registration of qualified agents/brokers is now open and a $100 flat enrollment fee will be paid in conjunction with successful enrollment of individuals effective September 1. • To qualify for participation you must: • Be an insurance agent or broker in good standing in your state. • Your license must be confirmed through the NIPR database. • Submit a completed W-9 form. • Hold a valid federal tax identification number (FTIN) or social security number (SSN). • Submit a completed EFT form for electronic payment. • Agree to accept payments via EFT. • PCIP broker referral program only applies to 23 states where the federal Gov runs the PPACA high risk pool program

  7. HHS Could Assume External Review Process • HHS issued its preliminary list of states not meeting the external appeals review requirement of PPACA • 23 states already have laws on the books that meet the strict standards • 10 states have similar standards that insurance companies will have to abide by until they bring their standards up to par by Jan. 1, 2014. • Appeals process for the rest of the states and five territories will be assumed by HHS or contract with an independent review organization. • States not in compliance include: • AL, AK, DC, FL, GA, LA, MA, MS, MT, NE, NH, ND, OH, PA, TX, WV, WI • All states have until Oct. 1 to appeal their HHS determination

  8. Other News… • HHS Issues Rules on Preventive Care for Women • Proposed Rule Released Regarding Health Insurance Cooperatives (CO-OP Plans) • Coalition Activity • ACO Working Group

  9. THANK YOU!! Next Legislative Update: September 14 at 1:00PM EST

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