April 12, 2019


In This Issue
Fast Facts
Senior Issues, State Innovations and Healthcare Cost Containment Dominate NAICís Spring Agenda
NAHU Submits Comments on the Trump Administrationís Drug Rebating Rule
Medicare-for-All Legislation Introduced in the Senate
Republicans Introduce AHP Legislation to Provide Legal Path for Invalidated Plans
State Spotlight: Oklahoma Mirrors Trump Administration with PBM Regulation
Healthcare Happy Hour: Special Guest Discussion on Balance Billing
Register for Next Weekís Webinar on Frequently Asked Compliance Questions
Applications Are Now Open for NAHUís Legislative Council
CMS Announces Agent and Broker Summit
Register Now for the State of the Long-Term Care Insurance Industry Webinar
HUPAC Roundup: Defining the Center
What We're Reading
E-mail the Editor
Visit the NAHU Website
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Senior Issues, State Innovations and Healthcare Cost Containment Dominate NAICís Spring Agenda
The National Association of Insurance Commissioners held its spring meeting in Orlando this week, and NAHU was there to represent the interest of health insurance agents before all of the state insurance regulators. The NAIC Senior Issues Task Force asked NAHU to present testimony about our ongoing efforts to provide health insurance agents and Medicare beneficiaries with accurate information about changes to the Medicare supplemental marketplace coming on January 1, 2020 as a result of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Besides speaking to the members of the task force about NAHU’s professional education efforts in Medicare arena, we also were able to discuss potential collaboration between the NAIC, NAHU and other advocacy groups about means to help Medicare beneficiaries navigate issues that come up with employer-sponsored plan coverage and COBRA, through both education and potential public policy changes.

The state insurance regulators devoted a significant amount of meeting agenda time to ways states can innovate in their health insurance markets, particularly to reduce costs. The Health Innovations subgroup discussed various state-level initiatives on ACA Section 1332 waivers, value-based purchasing, prescription drug pricing, mandates to maintain coverage and surprise billing, among other topics. The Regulatory Framework had Montana regulators present about a unique approach the state took to use transparent pricing/contracting to address costs in the State of Montana Benefit Plan, and the Health Insurance and Managed Care (B) Committee heard from multiple industry experts presenting data cost-driving trends in the marketplace and transparency efforts.

There was also a lot of focus on the implementation of the final rules regarding Association Health Plans (AHPs) and Short Term Limited Duration Plans (STPs). Just days before the NAIC met, the AHP final rule was dealt a blow when U.S. District Court Judge John Bates ruled that AHPs don’t meet the coverage rules of the ACA, violate ERISA, and are an illegal “end run” around the federal healthcare law. NAHU submitted comments on the AHP proposed rule, and cautioned about this possible challenge. An appeal is almost certain, but state insurance commissioners discussed their concerns with newly forming AHPs in light of the recent ruling. State law is not preempted by the federal regulation, and some states have already placed restrictions on the new federal rule. More states may follow suit in passing state restrictions, and others have considered halting approval of new AHPs until the litigation regarding AHPs has made its way through the court system. In the meantime, agents and brokers should check with their state insurance commissioner offices on the status of AHPs in their state if working with any clients interested in AHPs.

There were several presentations on STPs, with an emphasis on how consumers are interpreting the availability of STPs under the new federal rules. As with the AHPs, the federal STP regulation does not preempt state law, and states are able to put in place rules that are more strict than the federal rule. Some states have outlawed STPs altogether, while others have limited the duration, but the majority are implementing the new federal rule which allows STPs to be sold for up to 364 days and to be renewed under the discretion of the carrier for up to 36 months. The NAIC is interested in the STPs being sold around the country, and is exploring the possibility of collecting data on what companies are selling STPs, what benefits available STPs cover, and commissions for agents and brokers of STPs. From the presentations provided at the NAIC meeting, there is a concern about consumer protections and appropriate notices being given at the time of enrollment. NAHU submitted comments on the STP proposed rule. We recognize that STPs serve a purpose in the market and encourage agents and brokers to check with their state insurance commissioners to be sure they are complying with all state and federal laws when enrolling consumers in these plans.

Beyond these issues, upcoming ways that NAHU will continue to engage with the NAIC include our ongoing service on the board of directors of the National Insurance Producers Registry (NIPR), participating in newly planned discussions related to the Mental Health Parity and Addiction Equity Act, and monitoring activities related to data innovations, cyber security, and product suitability standards. We will also be providing input and assistance as the NAIC works on a new model regulation related to state-level pharmacy benefit manager licensing, and updates to existing model regulations and legislation related to excepted benefit products and HMOs.
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