Health Insurance and Managed Care (B) Committee

The following task forces and working groups report to the Health Insurance and Managed Care (B) Committee:

• Regulatory Framework (B) Task Force
  • ERISA (B) Subgroup
• Senior Issues (B) Task Force

Mission

The mission of the Health Insurance and Managed Care (B) Committee is to consider issues relating to all aspects of health insurance. The Committee oversees the activities of the Senior Issues Task Force and the Regulatory Framework Task Force.

2009 Charges  

1. Respond to inquiries from Congress, the White House and federal agencies; analyze policy implications and effect on states of proposed legislation; communicate NAIC’s position through letters and testimony when requested;

2. Develop appropriate regulatory standards and revisions to the NAIC models, consumer guides and training material, as necessary, Medicare supplement insurance, senior counseling programs and other insurance issues which affect older Americans. Report annually (Delegated to Senior Issues Task Force);

3. Develop appropriate regulatory standards and revisions to the NAIC models, consumer guides and training material, as necessary, on long term care insurance. Work with federal agencies as appropriate. Report annually (Delegated to Senior Issues Task Force);

4. Review and monitor state and federal relations with respect to senior health care initiatives, and other impacts on the states. Work with federal agencies as appropriate. Report annually. (Delegated to Senior Issues Task Force);

5. Coordinate and develop the provision of technical assistance to the states regarding state level implementation issues raised by federal health legislation. Report quarterly. (Delegated to Regulatory Framework Task Force);

6. Monitor, report, and analyze developments related to ERISA, and make recommendations regarding NAIC strategy and policy with respect to those developments. Report quarterly. (Delegated to Regulatory Framework Task Force);

7. Review model laws adopted in 2004 and recommend whether they be retained, revised or deleted. Report by 2009 Winter National Meeting;

8. Review the NAIC’s ERISA Handbook and modify as necessary to reflect developments related to ERISA. Report annually (Delegated to Regulatory Framework Task Force);

9. Oversee changes and provide technical assistance as appropriate to the production of the Accident and Health Statistical Compilation and Market Share Report. Periodically evaluate the demand, utility and income derived from these reports versus their cost;

10. Review issues surrounding the uninsured/underinsured and strategies for achieving universal coverage, determine what contributions state insurance regulators, from their unique perspective, can make to the debate, and develop appropriate vehicles to convey any positions or principles the Committee develops to a multiplicity of audiences. Report by 2009 Winter National Meeting;

11. Review managed health care reforms, their delivery systems occurring in the marketplace, and other forms of health care delivery; recommend appropriate revisions to regulatory jurisdiction, authority and structures. Report annually. (Delegated to Regulatory Framework Task Force);

12. Serve as the official liaison between NAIC and National Association of Managed Care Regulatory (NAMCR), the Joint Commission, the National Committee on Quality Assurance (NCQA), and URAC. Provide for coordination between this committee and NAMCR to facilitate input from NAMCR on improvements to the state regulation of health maintenance organizations (HMOs) and other managed care entities. Report annually;

13. Review issues surrounding internal appeals and external review with respect to regulatory modernization and determine whether national standards are appropriate. If so, recommend an appropriate vehicle to achieve goals. Report by 2009 Winter National Meeting (Delegated to Regulatory Framework Task Force);

14. Review issues surrounding evidence-based medicine and determine whether rigorous and consistent reporting should be required. If so, develop a model law on the topic or recommend another appropriate vehicle to achieve goals. Report by 2009 Winter National Meeting;

15. Continue to study and evaluate evolving long-term care insurance product design, rating, suitability and other related factors, and review the existing Long-Term Care Model Act and Regulation to determine their flexibility to remain compatible with the evolving delivery of long-term care services and remain compatible with the evolving long-term care insurance marketplace. Report quarterly (Delegated to Senior Issues Task Force);

16. Monitor and provide assistance to the States on the implementation of the 2000 rating practices amendments to the Long-Term Care Insurance Model Regulation. Report annually (Delegated to Senior Issues Task Force); and

17. Examine issues and, as necessary, state laws and/or regulations regarding appropriate underwriting questions on applications for health insurance coverage particularly with respect to ensuring that underwriting practices and HIV testing procedures are nondiscriminatory; and, if appropriate, develop a model law or model bulletin to reflect state law and/or regulations on the subject.