Examples of Insurers Stepping Up, Implementing Reform Measures Early

Insuring Resources Commentary:

The vast majority of insurers act with integrity and follow the law appreopriately. This article illusatrates how some are implementing reform rules early, it can only help them in the race to insure the currently uninsured. I highlight some key aspects below....


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Health insurers adopt some new rules early-


By David S. Hilzenrath
Washington Post Staff Writer
Friday, April 30, 2010

After being criticized as obstructionists during the long health-care debate, insurance companies now are implementing some popular provisions even sooner than the law demands.

Major insurers said this week that they will soon end the practice known as rescission, which involves going back and scrutinizing the applications of people who develop costly illnesses and dropping their coverage based on even minor or innocent misstatements.

In addition, dozens of health plans will allow dependents up to age 26 to stay on their parents' plans by this spring, months ahead of the September deadline -- a step that will be especially helpful to many families with students graduating from college.

Those promises follow an industry pledge not to exploit a potential loophole in a requirement that insurers cover children with preexisting conditions.

"Our focus right now is on implementing these reforms in a way that's going to minimize disruption and provide greater peace of mind for the more than 200 million people we serve," Robert Zirkelbach, a spokesman for the industry group America's Health Insurance Plans, said Thursday.

In each case, the industry's concessions were requested by the Obama administration or members of Congress. By quickly complying, insurers could repair their battered image and build goodwill with the administration, which drove the legislation to passage this year largely by going on the offensive against insurers.

For all concerned, the health-care battle is not yet over. Government officials must now translate the new legislation into more detailed regulations, and the industry's fortunes could rise or fall based on the eventual fine print. Meanwhile, candidates for House and Senate seats will be debating the legislation's merits.

The administration and congressional Democrats could benefit politically if voters see favorable results from the new law before they go to the polls in November.

Many Americans will find themselves unable to take advantage of the insurers' offer to extend family coverage for young adults this spring. The federal government told its workers last week that it is legally prohibited from granting that option until Jan. 1, 2011.

"Though we are eager to provide coverage to young adults prior to Jan. 1, the current law governing the FEHB [Federal Employees Health Benefits] Program specifically prohibits us from doing so," the Office of Personnel Management said. "We are working diligently with the Congress to address this matter."

Families covered by private-sector employers may have to wait, too. At big companies, it is often the employer rather than the insurer calling the shots; many large employers pay medical claims out of their own coffers and simply enlist insurers to administer the coverage.

Officials at two organizations for large employers, the National Business Group on Health and the ERISA Industry Committee, said Thursday that they did not know of any member companies offering to expand coverage for young adults ahead of schedule.

"Every employer I know is still trying to figure out what to do with this provision," said Steven Wojcik, vice president for public policy at the National Business Group on Health. "They're waiting, not sure how to react."

Employers are reluctant to make a short-term change before they know the long-term rules, said Gretchen Young, senior vice president for health policy at the ERISA Industry Committee, which takes its name from a federal law.

Employers are trying to figure out how to implement the provision, not just when. Questions include whether they will charge families additional premiums to let young adults stay on or rejoin their health plans. The law does not prohibit them from doing so.

The Internal Revenue Service removed one impediment for employers this week when it clarified that employees can take advantage of expanded coverage for dependents on a tax-free basis.

Spokesmen for some insurance companies interviewed Thursday said they did not know details of how their coverage for young adults will work, including whether it will involve extra premiums and whether the dependents' medical status will affect premium costs.

The White House posted a list of dozens of insurers that will offer the early coverage, including WellPoint, Cigna, Aetna, United HealthCare, Humana, Kaiser Permanente, and BlueCross and BlueShield plans. The offer could spare insurers the headaches of dropping people this spring only to restore them a few months later. The fact that young people tend to be healthier could mitigate costs.

WellPoint said earlier this month that, beginning June 1, its health plans will automatically keep dependents up to age 26 on their parents' policies in the individual market and in group health plans where the employers buy insurance. Employers that use WellPoint in a strictly administrative role will have the option of not offering extended coverage, WellPoint said.

Secretary of Health and Human Services Kathleen Sebelius asked WellPoint to end rescissions after a news report accused it of targeting women with breast cancer. WellPoint disputed the article but agreed to the request.
Congressional Democrats asked other companies to do the same.

Karen Ignagni, president of America's Health Insurance Plans, replied Wednesday that her group is committed to implementing the new standard for rescissions in May. Insurers are still permitted to revoke policies if the applicant made a fraudulent or intentional misrepresentation.

"It's heartening to see that the insurance companies who employed these terrible practices -- and fought reform -- are coming around doing the right thing by instituting the ban right away," Nancy-Ann DeParle, director of the White House Office of Health Reform, said in a statement. "We'll be watching closely and holding them to their word."

Implementation Discussion

Insuring Resources Commentary:

As the Dept of Health and Human Services begins the process of developing the administrative rules to implement the PPACA the industry and advocates are gearing up to influence this process.

The article below discusses the implementation of the Medicaid expansion, the temporary high risk pools, the fines, and the numerous pilot programs that the PPACA authorizes. The federal HHS will also need to set up the rules for the COOP programs (which the articel below fails to mention). That program authorizes the creation of Consumer Operated and Oriented Plans (COOPs) ---- these are non-profit health plans that can be created in states using federal grant funds. These grants will allow the creation of the COOPs by 71/1/2013.



WISCONSIN:
In Wisconsin I'll be heavily involved as the Commissioner of Insurance has stated that his Health Insurance Advisory council (which I am appointed to) will play a large role in advising OCI on implementation of its rules.

For instance, the PPACA requires each state to establish an Ombudsman office to aide consumers in navigating the State Health Insurance Exchanges. The OCI will also develop the rules regarding the implementation of both state-based Exchanges. The Small business Health Options Program (SHOP) is a state- based exchange for small businesses. In addition there will be a Health Insurance Exchange for individuals to gain access to insurance if they don't have employer-based coverage.


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Next phase in health care war: Applying the law
Cabinet braces for lobbying blitz by industry advocates
April 27, 2010
By John Fritze
USA TODAY

WASHINGTON — The debate in Congress over President Obama's health care law is done. The battle over how to carry out the law is just getting started.

Dozens of special-interest groups that helped shape the 10-year, $938 billion health care measure over the past year — from insurance companies to patient advocates — are gearing up for a second wave of lobbying as the Obama administration prepares to implement the law.

The U.S. Chamber of Commerce, which opposed the measure in Congress, is fighting to protect businesses that might be required to provide insurance, for instance. Drugmakers who supported the bill are monitoring how much they may have to discount prices.

Watchdog groups say patients can get lost in the lobbying blitz. "Industry dominates this process even more than they dominate the legislative process," said Robert Weissman of Public Citizen. "It's more of an inside game."

Congress gave sweeping power to federal agencies, especially the Department of Health and Human Services, to fill in gaps lawmakers left in the 906-page legislation — an effort that will take years. The law refers more than 1,000 times to Cabinet secretaries who will make decisions on how to carry out the law.

For example, the law requires insurance companies to spend 80% of premiums on medical claims, as opposed to administrative costs, by 2011. But it directs the health department to decide whether gray-area expenses, such as health-and-wellness programs offered by insurers, count as care or overhead.

Karen Ignagni, president of the industry group America's Health Insurance Plans, said her staff is "already geared up" and is providing data and suggestions on that and other issues to the department. But, she said, agencies implementing the law will weigh many arguments before making a decision.

"I don't think regulators are influenced by the classic sense of lobbying," she said. "There's a level playing field."

Unlike the legislative process, much of the battle over regulations takes place behind the scenes, Weissman said. The public may comment on proposed decisions, but many groups try to gain access to decision-makers early on, he said.

The health department declined to discuss industry attempts to influence implementation, but Secretary Kathleen Sebelius said in a statement that the department is "working closely with states, insurers, providers and other partners. … We want to hear from everyone."

Other looming battles over the new law include: •The health department must create high-risk insurance plans to provide temporary coverage for people with pre-existing conditions. Private insurers are watching to make sure those plans don't affect their bottom line, said Mark Pauly, a University of Pennsylvania health economist.

•Firms with more than 50 full-time employees would face fines in 2014 if they don't provide health insurance to workers. The Treasury Department must determine who qualifies as a full-time employee, a decision that will affect businesses on the edge of the 50-worker threshold. "We really have to make our case early," said Randel Johnson with the U.S. Chamber of Commerce.

•Health department officials must develop a review process to judge dozens of pilot programs created in the law — and decide whether they should be expanded. The National Partnership for Women & Families, a patient-advocacy group, wants the process to take quality of care into account. "It can't just be about saving money," the group's president, Debra Ness, said. "We also want to make sure they deliver better care."

Health care interests spent heavily on lobbyists as the legislation worked its way through Congress. In all, health industries spent $652 million in 2009, up 14% from 2008, according to the non-partisan CQ Moneyline.

Last year, the Obama administration passed a sweeping series of rules requiring federal agencies to disclose contacts their officials had with lobbyists about the economic stimulus. Similar rules do not exist for the health care law.

"We all want to … meet with folks to describe some of the issues and concerns we think need to be navigated," said Ron Pollack of Families USA, which supports the law. "I have no doubt that industry and others are going to be doing the same thing."

Dartmouth Atlas Launches New, Informative Website

Insuring Resources Commentary:


http://www.dartmouthatlas.org/?cid=xem-emc-ca

On the home page, on a map of the US you can see the wide disparities that exist here in Wisconsin on Medicare reimbursement per enrollee.

For example-
Milwaukee- $8,057
Wausau- $7,894
Marshfield- $6,975
Appleton- $6,935
Green Bay- $6,931
Madison- $6,813
La Crosse- $6, 008


Specifically I want to direct you to the following key topics discussed at great length within the website:

Effective Care: http://www.dartmouthatlas.org/keyissues/issue.aspx?con=2939

Accountable Care: http://www.dartmouthatlas.org/keyissues/issue.aspx?con=2943





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http://www.dartmouthatlas.org/?cid=xem-emc-ca


Here's an overview:
Understanding of the Efficiency and Effectiveness of the Health Care System
For more than 20 years, the Dartmouth Atlas Project has documented glaring variations in how medical resources are distributed and used in the United States. The project uses Medicare data to provide information and analysis about national, regional, and local markets, as well as hospitals and their affiliated physicians. This research has helped policymakers, the media, health care analysts and others improve their understanding of our health care system and forms the foundation for many of the ongoing efforts to improve health and health systems across America.

Health Insurers Analyzing Reform's Impact

Insuring Resources Commentary:

I've highlighted a couple of key points in the article below.

1. It is assumed that insurers will take advantage of the opportunity to "cherry-pick" customers while they still can--- in other words avoid covering the sickest individuals until they are mandated to do so.

2. Medicaid expansion will be a boon for insurers as states will seek to contract with managed care insurers to reduce costs per individual as the coverage expands to include many more individuals. This makes perfect sense and is an obvious way to improve health outcomes for individuals on Medicaid as managed care does generally reduce costs and improve care. And yet again, Wisconsin is way ahead on this as the state has contracted with managed care HMOs for years in its Medicaid program.

3. The third item is where the Feds need to ensure that the rules are tight on what insurers can do related to the risk-adjustment rules moving forward. The tighter the rules, the more effective this reform package will be in the long-run at controlling costs.




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Health insurers weighing options to get ahead of reform

By David S. Hilzenrath
Washington Post Staff Writer
Sunday, April 18, 2010

The idea was simple enough: Make sure that health insurers spend the vast majority of their revenue on patient care, instead of using it for things such as advertising, profits and executive pay.

To that end, the new health-care law says an insurer must give money back to consumers if it devotes less than 80 percent of premiums to paying medical claims and improving care. For insurers serving large groups, the target is 85 percent.

But even before the health-care overhaul was signed into law last month, one of the nation's largest insurance companies reclassified certain expenses in a way that increased its so-called medical-loss ratio. In January, WellPoint began including under medical benefits such costs as nurse hotlines, "medical management," and "clinical health policy," a WellPoint executive said in a March briefing for investors.

Redefining medical spending to make the requirement more attainable is just one way insurers might adapt to the new legislation.

Weeks after the law was enacted, insurers are still scouring it to figure out precisely what it allows. Many of the details won't be known until government officials translate the legislative language into specific regulations, and some of the tightest restrictions won't take effect for years. In the meantime, health insurers face tactical and strategic choices that could alter their short-term fortunes. Should they boost premiums before rates become subject to greater oversight? Should they step up efforts to avoid people with preexisting conditions before they are required to accept even the sickest applicants?

Some analysts say the new law gives insurers powerful motivation to try to increase profits and reserves while they still can.

"They will absolutely try to cherry-pick as much as they can get away with between now and when the legislation is fully implemented," said Wendell Potter, a former spokesman for big insurer Cigna.

Insurers might conclude that they should "get our prices up while we can because after the revolution we're not going to be able to," said Mark V. Pauly, a health-care economist at the Wharton School at the University of Pennsylvania.

But for all the incentives to get more aggressive in the short term, there are also counter-incentives, and it is hard to tell how they balance out.

From an economic standpoint, raising rates could cause insurers to lose business, especially in the more competitive markets.

From a regulatory standpoint, charging excessive premiums during the next few years could give authorities grounds to bar insurers from new marketplaces known as exchanges when they open for business in 2014.

From a political standpoint, pushing limits while officials are still writing the rules could boomerang for insurers. WellPoint's plan to raise rates in California by 39 percent fueled arguments for reform earlier this year and helped drive the legislation to final passage.

Some of the openings for insurers are plain to see. For example, although the law bans annual and lifetime limits on the dollar value of benefits, it does not ban limits measured in other terms. That leaves the door open to limits based on, say, the number of courses of treatment for an expensive problem such as infertility.

The coming expansion of Medicaid could trigger a land rush by private insurers seeking to manage care for Medicaid beneficiaries. In a report issued Thursday, big insurer UnitedHealth Group said state Medicaid programs serving low-income Americans could save billions of dollars by moving recipients into managed care.

(Private insurers have made the same argument about Medicare in years past, but the government has concluded that it was overpaying private health plans to care for Medicare beneficiaries. It cut such reimbursements in the recent legislation.)

Other issues are more complex.

Turning away the seriously ill while insurers still can might seem like an obvious choice. To be sure, the fact that insurance companies will be prohibited from rescinding policies once people get sick gives them cause to be more selective in the first place, said industry analyst Carl McDonald of Oppenheimer & Co.
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But in the not-too-distant future, some insurers will be subject to a process called risk-adjustment, which will attempt to neutralize the incentive to cherry-pick. Under risk-adjustment, health plans that attract disproportionately healthy populations will be penalized, and plans that attract disproportionately sick populations will be awarded additional payments. Depending on how the risk-adjustment rules are written, insurers could lock in a lasting advantage by cherry-picking more vigorously now, or they could see that benefit erased, said Jerry Flanagan of the advocacy group Consumer Watchdog.

Similarly, the requirement that insurers devote 80 or 85 percent of premiums to medical claims and related expenses creates conflicting incentives. At its simplest, it encourages insurers to cut overhead expenses. In addition, it might give insurers pause before raising copayments and deductibles, turning away applicants with preexisting conditions, or squeezing payments to doctors and hospitals, because each of those steps would reduce medical spending and make it harder for insurers to meet the required ratios.

On the other hand, the target ratios might give them added incentive to raise premiums. By doing so, they could keep overhead and profit fixed, even as those items decline as a percentage of the premium dollar.

WellPoint spokesman Jon Mills said in an e-mail that it is appropriate for his company to reclassify expenses related to the management of members' health.

In effect, WellPoint turned more than $500 million of administrative items into medical expenses, the Senate Commerce Committee's Democratic staff said in report Thursday.

Scott Serota, chief executive of the Blue Cross and Blue Shield Association, said the insurers in his group "are committed to make sure that both the letter and the intent of this law is implemented in a manner in which benefits all Americans.

"The cynic can find all kinds of opportunities here," he said. "That's just not what we're going to do."

Gallup Poll results concerning cost issues and health care reform

Here are some interesting poll results since the passage of health care reform. These questions were focused on cost.

Gallup released its latest poll on health care reform and the findings continue to echo the concern about health care costs that independent experts and economists have been raising (and that the Campaign has highlighted.) Here are some key findings from the poll:

"Proponents, as well as opponents, of the new healthcare reform law think the legislation is less than perfect. Both groups agree that the bill didn't do enough to deal with rising healthcare costs."

56% of independents do not think the bill does enough to address costs.

Even among those who think the bill was a good thing, 62% think the bill does not do enough to address costs.

Important Health Care Payment Reform Session

Insuring Resources Important Link:

I want to draw your attention to an important event that took place last week, on April 6th. Health care leaders from across the state met to discuss methods to improve health care payment methods to better reward health care quality and efficiency.

Please check this out:

http://www.createhealthcarevalue.com/blog/post/?bid=160

Here's an excerpt: "The Center has outlined what we think real health reform looks like. It boils down to three things: paying for value not volume, transparency of healthcare performance through public reporting, and redesigning the care delivery process to take out waste. We took a step closer to paying for value with the day long meeting in Pewaukee on (April 6th)." - Dr. Toussaint

Better Access to Preventive Care- key goal of health insurance reform

Insuring Resources Commentary:

This should go a long way toward improving health outcomes for many, many Americans, particularly for the chronically uninsured and underinsured who will now have first dollar coverage of preventive services-- no copays, deductibles, etc.





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From the NY Times
By LESLEY ALDERMAN
Published: April 9, 2010


A PRIMARY goal of the health care overhaul was to provide insurance for more people, namely those who could not afford coverage and those with pre-existing conditions for whom insurance was too costly.

But the new law also aims eventually to improve health insurance for everyone. By now you have probably read or heard about big changes like the rules that will require insurers to cover everyone who applies, regardless of health status, and forbid them from dropping people when they get sick.

You may not yet be aware, though, of another notable improvement to insurance, a change that could save a consumer or family hundreds of dollars a year. Under the new law, insurers must offer preventive services — like immunizations, cancer screenings and checkups — to consumers as part of the insurance policy, at no additional out-of-pocket charge.
The idea is that healthy Americans will be less costly Americans.

“This is transformative,” says Helen Darling, president of the National Business Group on Health, a nonprofit organization for large employers. “We’re moving from an insurance model that was based on treating illness and injury, to a model that’s focused on improving an individual’s health and identifying risk factors.”

The trend toward offering free preventive care has been gaining steam for a decade among large companies that provide employee health benefits. “Employers recognize that if they want to control costs, they have to persuade their workers to be healthier, including their children,” Ms. Darling said.

Three out of four large companies now offer free preventive health services to their workers, according to a 2009 survey by Mercer, a benefits consulting firm. Smaller employers, though, and individual health plans have been less likely to offer free care of any type.

But under the new law, more generous “wellness” benefits should eventually be available to almost all Americans with insurance.

“Eventually” is the operable word, though. Although this feature of the law goes into effect at the end of September, it will apply to new insurance policies only. That means if you switch to a different policy, or buy a new one, the preventive services will be offered.

But if you are already in a plan, your benefits probably will not be upgraded until the plan makes a significant change, like modifying its cost structure. Simply signing up again during next fall’s annual enrollment for the same coverage you now have may not necessarily cause the new preventive-care requirement to begin. Until the Department of Health and Human Services actually writes the new regulations for this and many other parts of the law, though, no one can say for certain what will count as a event that sets the preventive care requirement in motion.

A clear exception is Medicare. Starting next year, all enrollees — even if they do not change insurance plans — will be entitled to a free annual checkup and free screenings, like colonoscopies and mammograms.

For people of all ages, many details of the new prevention benefits will remain sketchy until Health and Human Services writes the rules.

“Here, as with many other places in the legislation, much will depend on how H.H.S. writes the implementation regulations,” says Timothy S. Jost, a professor of law at Washington and Lee University School of Law and an expert on health reform.

Generally, though, here is how preventive services will be integrated into health insurance plans, beginning this fall.

NO OUT-OF-POCKET FEES New group and individual health plans must provide preventive health services at no additional charge to consumers — the services will not be subject to a co-payment or to a deductible.

BASED ON FEDERAL GUIDELINES The preventive services will include those that the United States Preventive Services Task Force, a panel of outside experts under the Health and Human Services Department, has given their top A or B rating, like screenings for H.I.V., depression, osteoporosis in postmenopausal women, as well as breast, colorectal and cervical cancer. Children will receive free screenings for conditions including iron deficiency, sickle cell diseases and hypothyroidism. A government Web site has a handy calculator that lets you enter a person’s age and gender to see what those screening recommendations would be. (We have also posted the task force’s entire list of recommendations with the online version of this column.)

In addition, immunizations recommended by the Centers for Disease Control and Prevention will be covered, including vaccines for Hepatitis A & B, tetanus-diphtheria, seasonal flu vaccines and human papilloma virus for girls 9 to 26 years old.

WHEN IT TAKES EFFECT The parts of the law governing preventive care go into effect on Sept. 23 (six months after it was signed by the president). At that point, new plans, and plans that make changes, must start to offer free preventive care. If you are covered by Medicare, the upgrades will go into effect on Jan. 1.

If these changes sound too far off, or you have resigned yourself to not seeing any benefit because you will not be changing insurance plans any time soon, take note: if you have group coverage, you may already be entitled to some free preventive benefits. Check what your plan offers, either by calling the toll-free customer service number on your membership card, looking at your insurer’s Web site, or reading the plan’s summary plan description booklet (free services are usually listed up front).

“Employees tend not to read their benefits information,” Ms. Darling said.

One of your best health habits should be to make good use of the services that will not cost you a cent.

State of WI Creates Office of Health Care Reform

Insuring Resources News Update:


State creates health care reform office

By Guy Boulton of the Journal Sentinel

Posted: April 7, 2010 10:14 p.m. |

Gov. Jim Doyle has created an Office of Health Care Reform to prepare for the sweeping changes from health care reform that take effect in 2014.

Those tasks will range from developing an exchange, where individuals and small businesses will be able to buy health insurance, to helping people understand the pending changes.

"Our direction now is pretty simple. It isn't to rehash the political debate," Doyle said at Froedtert Hospital on Wednesday. "It isn't just to fight this all out. It is to make sure we are really looking out for Wisconsin citizens."

The new office will be overseen by Karen Timberlake, the secretary of the Department of Health Services, and Sean Dilweg, the state insurance commissioner.

Some changes from the new law take effect immediately.

Small businesses that provide health benefits to their employees, for example, may be eligible for tax credits this year, Doyle said. The new Office of Health Care Reform will help make small businesses aware of the credit.

But implementing the most significant changes will take years. And designing easy-to-use exchanges - basically Web sites - will be one of the key tasks.

The health plans sold on the exchange will be required to offer a minimum standard of benefits, enabling consumers to make apples-to-apples comparisons when shopping for health insurance.

The exchanges are expected to offer a choice of benefit packages from a variety of insurance companies. People and families with incomes of up to 400% of the federal poverty level - $88,200 for a family of four this year - also will be eligible for subsidies to offset the cost of the coverage.

The sites also could provide consumer information on a health plan's performance.

The exchanges could be one of the most significant changes from the new law, with some economists contending they could increase competition among health insurers by allowing consumers to easily compare plans and their costs.

But the exchanges also could force insurance agents who sell individual policies out of the market. For one thing, health insurers will not have to pay sales commissions for the policies sold on the exchanges.

The exchanges also could affect agents and brokers who focus on small businesses.

Dan Schwartzer, executive vice president of the Wisconsin Association of Health Underwriters, which represents agents and brokers, said the effect is uncertain. But he said most small businesses probably would continue to work with agents because of their understanding of the market.

Doyle said he hoped to have an exchange up before 2014. But how that would work is unclear.

Before 2014, health insurers will not be required to cover people with pre-existing conditions. Health plans also would not be required to offer a minimum set of standard benefits, making apple-to-apple comparisons difficult. And small business rates would remain tied to the medical claims of their employees.

Schwartzer also noted that setting up the exchanges before 2014 could cause additional confusion when the new regulations kick in.

Health Care Implementation Details Discussed at the NAIC

Insuring Resources Commentary:

As I've mentioned I'm a member of the Wisconsin Insurance Commissioner's Health Insurance Advisory Council. Our next meeting is April 13 and I expect the issues detailed in the article below will consume the majority of our agenda and discussion.

As the article states implementation of health care reform is going to be job 1 for insurance commissioners over the next five to ten years.

I'm looking forward to aiding in the implementation.


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Health Care Implementation Details Discussed at the NAIC

By ALLISON BELL
National Underwriter

State regulators tried to get an idea of how big is big this past weekend as they talked about implementing the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act.

President Obama created years–and possibly decades–of work for state insurance regulators, state health regulators, and the National Association of Insurance Commissioners, Kansas City, Mo., when he signed the bills creating PPACA and HCERA into law.

Policy experts are just starting to dig behind the act summaries and read the actual language in the new laws, but thoughts about just what state insurance regulators will have to do to put PPACA and HCERA into effect came up often at the NAIC’s spring meeting in Denver.

News surfaced that U.S. Health and Human Services Secretary Kathleen Sebelius, a former Kansas insurance commissioner and former NAIC president, already has hired Jay Angoff, a former Missouri insurance commissioner, to help her communicate with the NAIC and keep tabs on the private insurance market.

Kevin Lucia, a Georgetown University health policy researcher who receives NAIC funding to represent consumer interests in NAIC proceedings, tried to give members of the NAIC’s Consumer Liaison Committee an idea of the size of the task facing regulators by discussing PPACA provisions that refer directly to the NAIC.

The committee has posted Lucia’s list of those provisions on its Web site.

Some of the PPACA sections cited will do the following:

—Require the U.S. Department of Health and Human Services to consult with the NAIC to develop the summary of benefits and coverage disclosure documents required under the act.

—Create health plan external review procedures that must comply with the NAIC’s Uniform External Review Model Act.

—Require HHS officials to define permissible health insurance pricing age bands in consultation with the NAIC.

—Provide that the new health insurance exchanges must use a “uniform enrollment plan that takes into account criteria submitted by NAIC to HHS.”

—Require HHS to work with the NAIC to set the regulations needed to create the exchanges; establish qualified health plan requirements; and create risk-adjustment and reinsurance provisions and other terms of the insurance reform.

—Require NAIC to help figure out how commercial long term care insurance policies will or will not coordinate with the new CLASS Independence Benefit federal long term care benefits program.

Lucia suggests in a separate document that PPACA and HCERA indirectly will create a need for the NAIC to help with many other tasks.

“As states consider the list of legislative and regulatory tasks before them, many will seek other ‘best practice’ recommendations from NAIC, even if not required by the legislative language,” Lucia says in the document. “For example, new premium rate review standards, to be used by state and federal regulators in connection with the 2010 plan year, are an area in which the NAIC will likely need to play a larger role than the one envisioned in the federal legislation.”

NAIC will have just 6 to 9 months to give HHS officials recommendations about many PPACA and HCERA provisions, Lucia says in the document.

Also at the spring meeting, the NAIC took these actions:

—Adopted Actuarial Guideline 43-CARVM, which sets variable annuity reserving guidelines.

—Adopted a white paper on methods for helping troubled companies.

—Adopted a guideline on life and health guaranty fund disclosure notices.

In addition, the NAIC’s Internal Administration Subcommittee took these actions:

—Adopted a proposal to reinstitute salary increases for NAIC staffers effective July 1. Salaries were frozen July 1, 2009. The NAIC can increase salaries about 3.5% because its defined benefit pension plan has been doing better, officials say.

—Adopted a proposal to restructure the lines of credit that the NAIC provides for the Interstate Insurance Product Regulation Commission. The NAIC will defer principal and interest payments owed by the IIPRC until the IIPRC makes a profit of $250,000 or achieves an accumulated cash balance from operations of $500,000, officials say.

The NAIC’s Life Insurance and Annuities Committee took these actions:

—Released several valuation manual section drafts for public comment. They include sections on experience reporting requirements and reporting formats and a section on principles-based report requirements for business subject to a principle-based reserve valuation.

Also at the spring meeting, the Executive Committee of the NAIC announced it had established a Market Regulation Accreditation Task Force; a Multi-State Enforcement Task Force; and a Regulatory Modernization Task Force.

And in another development, the Accident and Health Working Group found that the 1985 NAIC cancer cost tables cannot be replaced because of a lack of data. The group is asking the American Academy of Actuaries, Washington, to help insurers and regulators cope with the deficiency by “giving “appropriate guidance on current application of the 1985 tables.”