1 / 8

Implementing Commercial Insurance Market Aspects of Federal Health Reform:

Implementing Commercial Insurance Market Aspects of Federal Health Reform:. A State Perspective Christopher F. Koller Health Insurance Commissioner, State of RI April 30, 2010. Overview. What we are doing now What we need to be thinking about for the future States’ Challenges and Needs.

mikel
Download Presentation

Implementing Commercial Insurance Market Aspects of Federal Health Reform:

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Implementing Commercial Insurance Market Aspects of Federal Health Reform: A State Perspective Christopher F. Koller Health Insurance Commissioner, State of RI April 30, 2010

  2. Overview • What we are doing now • What we need to be thinking about for the future • States’ Challenges and Needs

  3. Issues Now: • High Risk Pool Grants ($5 billion – 2010-2013) • For individuals who currently do not have coverage and have a pre-existing condition • Challenges: for states without high risk pool and for guarantee issue states • Commercial Insurance Reforms (Plan years 6 mos. after enactment) • No lifetime limits; First-dollar coverage for preventive services • No rescissions; Appeals process • Dependent coverage up to 26 years of age • No Pre-existing Condition Exclusions for Children • MLR standards. Rate Oversight • Challenges: Reg promulgation process, communications, fit with existing statutes, implementation, other mkt impacts. Resources • Grants for State Ombudsman • National Web Portal

  4. Key Reforms – 2014 Implementation Market Reforms: • Guarantee Issue and no Pre-existing Condition Exclusions in all markets • Rating Reforms limiting factors to age (3:1), geography, tobacco use and family composition • 4 Coverage Tiers based on coverage categories and cost-sharing • No annual limits State-Based Exchanges for Individual and Small Group markets that will provide standardized information on insurance choices and help consumers enroll in plans

  5. State Action for Long Term Reforms: • (Stages of Grief) • Interagency Planning Groups • DC Monitoring (use of Membership Assocns) • Stakeholder Education and Communication • Exchange Planning: • Goal setting • Commercial and Medicaid interaction • Operations • Eyes on the prize: Long term vision for local delivery systems (the cost issue) – payment reform, HIT, benefit design etc.

  6. ME MN WI PA IA OH MD NE WV VA MO KY KS TN GA SC AR MS LA Small Group Premium Variation NH VT WA MT ND MA NY OR RI SD ID MI CT WY NJ DE IN IL NV UT CO CA DC NC OK AZ NM AL HI TX FL AK Rating Band Variability: Community Rating 13:1 or less Adjusted Community Rating 13.1:1 – 19:1 No Rating Structure 19.1:1 – 25:1 *Note: Michigan HMOs and Blue Cross/Blue Shield are restricted to 3.12:1 maximum variation. All others may use 3.96 maximum variation 25.1:1 or greater

  7. ME VT NH MN NY WI MI PA IA OH MD NE IN IL WV VA MO KY KS NC TN GA AL SC AR MS LA FL Individual Market Rating Rules WA MT ND MA OR ID SD RI CT WY NJ DE NV UT CO CA DC OK AZ NM HI TX AK No Rating Structure Community Rating Adjusted Community Rating Rating Bands Hybrid Michigan Blue Cross/Blue Shield must use community rating. There is no rating structure for other carriers.

  8. State Needs and Challenges • Federalism made real: Coming into compliance from tremendously different starting points: technical and political issues. • “Grandfathering” of old plans (see briefing sheet). Enormous implications – good politics; bad policy. • New Federal “Partnerships” - HHS OCIIO. • Competence is crucial. • New roles • Communication and expectations with local stakeholders • Resources Resources Resources

More Related