For months now, the NAIC and HHS have been toiling away at implementing various aspects of health care reform, not the least of which is annual review of unreasonable rate increases required under Section 2794 of the Public Health Service Act. The NAIC has announced that on Thursday, December 16, the Joint Executive/Plenary Committee will hold a conference call to consider a number of PPACA-related items, including the Rate Filing Disclosure Form to be submitted in connection with review of “unreasonable” increases. With this form on the agenda (and it having already being referenced in some states’ filing requirements), perhaps there will be resolution soon by the NAIC with transmittal of the form to HHS for its review and implementation.
Still shrouded in mystery, however, is how HHS will ultimately define what an unreasonable rate increase is – a complex issue, no doubt, encompassing rate review processes, public web site disclosure of increases deemed “unreasonable,” and even the prospect of insurers eventually being denied entry into state exchanges based on a history of unreasonably increasing rates. In a September 9th letter to AHIP President Karen Ignagni, HHS Secretary Kathleen Sibelius indicated that a regulation addressing potentially unreasonable increases would be issued later in the fall, although to date that guidance is still being awaited. The background and project summary accompanying the Rate Filing Disclosure Form being considered at the upcoming NAIC plenary meeting underscores the continuing need for HHS clarification on this question, as well as on how states should handle rate increase issues concerning large groups.
Meanwhile, requirements for annual reviews and posting of “unreasonable” premium increase justification on state and insurer web sites required by Section 2794 are now appearing. We’ve seen related filing and website posting requirements coming from states such as Connecticut, California, Montana, Michigan, and Oklahoma, and it’s hard to imagine that more of the same isn’t on the horizon.
Also, following up on an earlier post mentioning culturally and linguistically appropriate language requirements for summaries of benefits and coverage, the plenary session agenda also includes consideration of a Glossary of Health Insurance and Medical Terms, Summary of Benefits and Coverage and Instructions for Individual and Group Insurers, developed by the NAIC Consumer Information (B) Subgroup. The document provides proposed definitions and standards and describes the process used by the subgroup to develop them.
I’ll be updating the information on the outcome(s) of the December 16 conference call as soon as it’s made available.
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