Transcript Slide 1
What’s Ahead for the Health Insurance Market State of Reform Conference January 8, 2014 Reminder of OIC’s Role • Dual mission – Promote robust insurance market – Protect insurance consumers • Regulatory authority OIC Authority Limited or No Authority Fully-insured individual plans Medicaid, Medicare (some), UMP Fully-insured small group plans Self-insured plans Fully-insured large group plans Health care providers 2 Legislative Priorities • NAIC Model Laws – – – – Holding Company Act Own Risk and Solvency Assessment Credit for Reinsurance Standard Valuation and Forfeiture • IRO appeals for long-term care insurance 3 Rulemaking Priorities • Network access rulemaking, part 2 – Context: Split first rulemaking into two parts – Goal: Clarify remaining standards, primarily the maintenance of networks over the plan year • Prescription drug prior authorization – Context: Legislative directive to improve prior authorization process for prescription drugs – Goal: Adopt best practice recommendations of OneHealthPort working group 4 Rulemaking Priorities • Patient privacy protection – Context: Confusion about consumers’ rights to privacy in billing and explanation of benefits – Goal: Clarify expectations for issuers, consumers, and providers • Formulary transparency – Context: Consumers not aware of right to ask for formulary up front and costs difficult to estimate – Goal: Clarify consumer right to formulary information at point of sale 5 Other Priorities • Mental health & substance use parity enforcement – Context: Supreme Ct. ruling bolsters parity rules – Goal: Eliminate blanket exclusions or age-based discrimination for mental health services • Continue transition for group market – Context: Federal law require transition of some plans previously offered in large group market – Goal: Continue process begun in 2011 to transition these plans to the appropriate market 6 Other Priorities • Database of health IRO appeals – Context: Decisions in health IRO appeals not readily available to consumers – Goal: Enhance consumer awareness of existing appeals process through database of decisions • Preventive services standards – Context: Uneven implementation of ACA preventive services requirements – Goals: Partner with DOH and others to interpret and clarify federal preventive services standards 7 Other Priorities • Health Policy Roundtable – Context: Next phases of health reform will benefit from collaboration with diverse stakeholders – Goal: Provide a regular forum to discuss OIC priorities and activities around health insurance policy 8 Questions? Emily Brice Senior Health Policy Advisor [email protected] 9