States Move To Implement Health Reform Provisions
cmonfils | September 19, 2011
CCH® BENEFITS — 09/01/11
from Spencer’s Benefits Reports: According to the Kaiser Family Foundation’s State Health Facts, 23 states have established American Health Benefit Exchanges under the Patient Protection and Affordable Care Act (ACA), have enacted legislation with the intent to establish an Exchange, or have Exchange legislation pending.
Massachusetts and Vermont have established Exchanges, while California, Colorado, Connecticut, Hawaii, Maryland, Nevada, Oregon, Vermont, Washington, and West Virginia have enacted legislation to establish an Exchange. Hawaii’s Exchange will be a nonprofit, Vermont Exchange will be operated by the state. The rest of the Exchanges will be quasi-governmental.
The Exchange will be a clearinghouse and contract with all qualified health plans in Colorado and Hawaii. In California, Connecticut, Oregon, and Vermont, the Exchange will be an active purchaser contracting with selected health plans and/or negotiating premium prices with health plans. The other states have not yet decided the type of Exchange they will operate.
In Illinois, Indiana (by executive order of the governor), North Dakota, and Virginia, legislation has established the intent to set up an Exchange, while Alabama (by executive order of the governor), Georgia (by executive order of the governor), Mississippi, and Wyoming will study the feasilibility of an Exchange.
The District of Columbia, New Jersey, North Carolina, and Pennsylvania have Exchange legislation pending.
For more information, visit http://statehealthfacts.kff.org/comparemaptable.jsp?ind=962&cat=17.
Rate Review Programs
The federal government will either conduct or assist health insurance rate reviews in nine states, according to the most recent fact sheet from the Center for Consumer Information and Insurance Oversight (CCIIO), which discusses the rate review requirements included in the ACA.
According to the CCIIO, as of Aug. 15, 2011, state rate review procedures were as follows:
43 states, the District of Columbia, and one U.S. territory have effective rate review in at least one insurance market;
41 states, the District of Columbia, and the U.S. Virgin Islands have effective review for all insurance markets and issuers.
In two states (Virginia, Pennsylvania), the federal government will partner with the state to conduct reviews; and
The federal government will conduct reviews in seven states (Wyoming, Montana, Missouri, Louisiana, Idaho, Arizona, and Alabama) and four U.S. territories (American Samoa, Guam, Northern Marianas Islands, and Puerto Rico) until those areas are able to strengthen their review processes and authorities.
Starting Sept. 1, 2011, insurers seeking rate increases of 10% or more for non-grandfathered plans in the individual and small group markets are required to publicly disclose the proposed increases and the justification for them.
For more information, visit http://cciio.cms.gov/resources/factsheets/rate_review_fact_sheet.html.
