Health Insurance and Managed Care (B) Committee

Health Insurance and Managed Care (B) Committee
March 31, 20008

The Health Insurance and Managed Care (B) Committee met on Monday, March 31, 2008.

During this meeting, the Committee:

Received the Jurisdictional and Extraterritorial Issues (B) Subgroup report. At the 2007 Winter National Meeting, the Health Insurance and Managed Care (B) Committee adopted, as a project for 2008, the review of issues pertaining to state jurisdiction over extraterritorial health insurance business. One of the priorities of the Committee is to develop a white paper on state extra-territoriality best practices. The Committee authorized the formation of this Subgroup to work on this project. To help gather information for the white paper, the Subgroup developed a survey which was recently sent to department of insurance health insurance contacts. The Subgroup is requesting survey responses on or before March 7, 2008. After the Subgroup reviews the survey responses, the Subgroup plans to develop a framework for the paper and begin its work.

Received the Health Innovations (B) Working Group report. The Working Group heard two presentations. Isabel Friedenzohn from the Robert Wood Johnson Foundation’s State Coverage Initiatives made a presentation related to health care cost containment. She discussed the causes of escalating health care spending and described some steps that states are taking to improve the efficiency of health care and to improve management of chronic conditions. Commissioner Thabault (VT) discussed Vermont’s Blueprint on Health.The goal of the Blueprint is to create a standardized system of care that improves the lives of individuals with, and at risk for, chronic conditions. NAIC staff updated the Working Group on the Catalog of State Innovations. NAIC staff is currently revising the catalog to provide more comprehensive treatment of the areas of innovation, and better organization. The Working Group discussed its future work plans. The Working Group is considering holding a hearing at the Summer National Meeting in San Francisco to gather testimony from stakeholders on health care cost containment issues. There was also discussion of what the Working Group’s final work product should be. One or more white papers and the catalog of state innovations were suggested by various members of the Working Group.

Received the Regulatory Framework (B) Task Force report. During a conference call on March 14, 2008, the Task Force adopted the Uniform Health Carrier External Review Model Act. The Committee decided not to take action on the proposed new model to allow additional time to try to address some concerns expressed by regulators and interested parties. The Committee anticipates holding a conference call prior to the Summer National Meeting to take final action on the proposed new model . The Task Force discussed developing a PEO informational paper. NAIC staff will prepare an outline of the proposed paper for review at the Summer National Meeting. The Task Force received a report from the ERISA Subgroup. The Subgroup released for comment the Draft Regulator Alert -- Department of Labor Advisory Opinions 2007-06A When is a MEWA Fully Insured? and the Draft Regulator Alert – State Laws Giving Professional Employer Organizations (PEO’s) The Legal Status of Employer of Client Employers’ Workforce Can Open the Door to ERISA Preemption and State Law Challenges to State Restrictions on PEO’s Self Funding of Health Benefits. The Subgroup then met in Regulator-to-Regulator Session to discuss ongoing federal and state investigations into unauthorized MEWAs.

Received the Senior Issues (B) Task Force report. The Task Force accepted the March 25, 2008 Draft Long Term Care Data Call & Analysis Report. The Report was an analysis of the data received from 23 long-term care insurance companies that responded to a joint long-term care insurance data call by the Senior Issues (B) Task Force and the Market Analysis (D) Work Group. The Task Force asked, and the Committee agreed, to hold the Report to allow for additional comment. The Committee intends to hold a conference call prior to the Summer National Meeting to accept the Report. The Task Force noted that Iowa has legislation that, among other things, establishes an external review process for long term care insurance consumers. The Task Force formed a Subgroup to review the Iowa legislation and consider whether the Long-Term Care Insurance Model Act and Regulation should be revised to include similar provisions. NAIC staff provided an update on the implementation of the long-term care Partnership Program. The Task Force received a federal update on possible legislation regarding marketing and sales of Medicare private plans, including Medicare Advantage plans and Medicare Part D prescription drug plans. The Task Force received an update from the Medicare Private Plans Subgroup. The Subgroup is working on a white paper, exploring the issues of marketing and sales for Medicare Advantage and Medicare Part D prescription drug plans. The Subgroup is likely to finish their work in June. The Accident and Health Working Group provided an update to the Task Force on its work regarding the Medicare Supplement refund formula, as well as language the Task Force sent to the Working Group for the Medicare Supplement Compliance Manual regarding New or Innovative Benefits. The Task Force received an update on implementation of an information-sharing Memorandum of Understanding (MOU) between state Departments of Insurance and CMS. All but three states have now signed an MOU with CMS, and CMS has recently provided states access to their electronic health plan management system. Finally, CMS updated the Task Force on a number of Medigap-related issues.

Received the Accident and Health Working Group report. The Working Group discussed modifications to the Actuarial Opinion section of the Health Annual Statement Instructions. The Working Group recommended that the Life and Health Actuarial Task Force invite the Casualty Actuarial and Statistical (C) Task Force to form a joint subgroup to discuss making the process to name the appointed actuary consistent in all lines of business. The Working Group also discussed the project to update the refund calculation in Appendix A of the Model Regulation to Implement the NAIC Medicare Supplement Minimum Standards Model Act. The Working Group decided to put the project on hold while the proposed changes to the Social Security Act are being considered. The Working Group reviewed suggested language from the Senior Issues (B) Task Force for a section in the NAIC Medicare Supplement Insurance Model Regulation Compliance Manual regarding innovative benefits. A subgroup was appointed to review this section and any other changes that would be required in the Compliance Manual. The Working Group reviewed two sections of the proposed valuation manual, VM-25 – Health Insurance Reserves Minimum Reserve Requirements and VM-26 – Credit Life and Disability Reserve Requirements.

Received an update on federal issues. NAIC staff highlighted a number of federal bills.

Action Items:

None.