Health Insurance and Managed Care (B) Committee
Health Insurance and Managed Care (B) Committee Page
Joint Executive (EX) / Plenary Committee Summary Report
Winter 2009 Meeting Summaries Index

The Health Insurance and Managed Care (B) Committee met Dec. 7, 2009. During this meeting, the Committee:

• Adopted its Nov. 9 conference call minutes.

• Adopted the revisions to the Uniform Health Carrier External Review Model Act (#76). The revisions add four new appendices:
• A model notice of appeal rights.
• A model external review request form.
• A model independent review organization external review annual report form.
• A model health carrier external review annual report form.

• Received testimony from the American Medical Association regarding the “AMA Campaign to Secure Meaningful and Transparent Health Care Benefits.”  

• Adopted the report of the Regulatory Framework (B) Task Force, which included adopting its Oct. 13 conference call minutes. During its meeting, the Task Force reviewed and discussed a draft rescission data call report. The Task Force is requesting additional comments on the report from regulators and interested parties. The Task Force plans to hold a conference call sometime before the end of the year to review the comments and continue its discussions concerning next steps regarding the report.

• Adopted the report of the Senior Issues (B) Task Force. The Task Force received an update on the Long-Term Care Partnership program. There are now partnership policies available for sale in 31 states. State plan amendments have been approved in five additional states. The Task Force discussed state implementation of revisions to the Model Regulation to Implement the NAIC Medicare Supplement Insurance Minimum Standards Model Act (#651), as required by the federal Genetic Information Nondiscrimination Act (GINA) and the Medicare Improvements for Patients and Providers Act (MIPPA). Forty-eight jurisdictions (including Puerto Rico and the District of Columbia) have adopted the revisions. Three states are waived from the federal requirement. One remaining state is moving quickly toward final adoption, pending approval from the state legislature. The Task Force received a report from the NAIC-CMS (Centers for Medicare and Medicaid Services) policy group, which held a conference call Nov. 18, during which the group discussed issues of mutual interest. It is anticipated that this group will continue to hold regular conference calls and may meet in person again in 2010. The Task Force received a report from a CMS representative on Medicare supplement issues, including a verbal overview of a pending response letter from the CMS Administrator regarding Medicare supplement hospital network arrangements. This letter reportedly states that CMS believes there is no federal authority to block such arrangements, but states continue to have the authority to disapprove them. Task Force members expressed concern about CMS’ response and will consider developing additional guidance for state regulators. The Task Force received a report from a CMS representative on Medicare private plan issues. This month, nonrenewal notices will be sent to 412,000 beneficiaries for Medicare Advantage and Medicare prescription drug plans who are not renewing their contracts for 2010.
  • Adopted the report of the Accident and Health Working Group of the Life and Health Actuarial Task Forc. The Working Group adopted modifications to the Actuarial Opinion section of the Health Annual Statement Instructions for 2010. The Working Group discussed VM-25, the section of the valuation manual for health insurance. The Working Group decided to continue the discussion on a future conference call. The Working Group decided to modify the Medicare Supplement Compliance Manual to state that Medicare supplement plans of the same letter should be pooled for rating purposes. The Working Group appointed a subgroup to review several proposed changes to the Accident and Health Policy Experience Exhibit. The Life and Health Actuarial Task Force volunteered the actuarial services of the Working Group to work with the newly created Long-Term Care (EX) Task Force, which met for the first time Dec. 6.