The National Association of Insurance Commissioners (NAIC) met from November 19-22, and NAHU was present monitoring the proceedings and providing input to the state insurance regulators. NAHU provided testimony during a public hearing held by the MLR Quality Improvements (QI) Subgroup. The purpose of the hearing (and the subgroup) is to review the existing activities that health plans can count as “quality initiatives” and count as part of the health plan’s claims costs in the MLR equation. In addition, the committee requested comments on new activities that should be considered as quality initiatives in the future. The committee’s charge is to make recommendations to HHS on quality improvements only by the spring of 2016, and then HHS will make the ultimate decision about potential changes to the approved list of quality initiatives. In addition to NAHU, America’s Health Insurance Plans, the American Medical Association, the National Committee for Quality Assurance and the American Diabetes Association representing the NAHU-funded consumer representatives presented testimony. The testimony and official summary of the public hearing can be found here.
NAHU’s testimony was generally well-received. However, the vast majority of the follow-up questions directed to us concerned our support for allowing fraud as a QI and asking for more specifics about how fraud detection contributes to QI in the market today. Obviously, NAHU could not provide plan specific data but we did provide examples about how cyber security breaches could present QI issues and the regulators indicated that they agreed that could potentially be an issue and was not something originally considered five years ago. Another well-received point was about not limiting health plan innovation and competition and incenting QI initiatives within plans. There was a significant amount of concern about how QI/MLR limitations could be hindering competition by smaller and regional plans. Subgroup members requested more detailed information on the recommendations of the speakers, especially on value-based care initiatives and antifraud expenditures from all interested parties, specifically with from health plans with specific detailed examples. Additional written comments may be submitted up until January 15.
In addition to working on the MLR quality improvement recommendations for HHS, the NAIC is working on a number of interesting issues that could impact agents and brokers and the health insurance market generally. For example, the Regulatory Alternatives Working Group is going to be focusing on both cost containment and Section 1332 ACA State Innovation Waivers in 2016. This is also a potential area of great opportunity for NAHU, given that intersection of the private insurance marketplace, employer-sponsored coverage and premium assistance are all potential areas of Section 1332 waiver application scope by states. In addition, the Regulatory Framework Task Force is going to start reviewing and revising the NAIC’s model acts regarding excepted benefits and pharmacy benefit management. The ERISA Working Group is working on updating the ERISA handbook for state regulators to address ACA provisions and NAHU was also asked by regulators to participate in a small task force with regulators, industry, and consumer representatives to ensure that agents are well-educated about the future availability of Medigap Plans C and F post-2020. The NAIC is also poised to open up its model privacy act and regulation to address both cyber security protections and provisions to potentially allow for electronic distribution of privacy disclosure notices.
Finally, at its plenary meeting on November 22, the NAIC approved a final version of the Network Adequacy Model Act. They also announced the election of the 2016 NAIC officers. Director John M. Huff (MO) was elected president, Commissioner Sharon P. Clark (KY) becomes president-elect, Commissioner Ted Nickel (WI) was elected vice president and Commissioner Julie Mix McPeak (TN) became secretary- treasurer.