Checking in on the NAIC: Work in Progress to Update Model State Laws to Comply with the Affordable Care Act

When CHIRblog last checked in with the National Association of Insurance Commissioners (NAIC), they were wrapping up their Spring meeting in Houston, TX. That meeting held fewer controversies relating to the ACA than some in the past, in part because the NAIC has completed many of the tasks required of it by the law, such as providing HHS with a recommended medical loss ratio standard, developing the template for insurers to justify premium rate increases, and drafting a consensus recommendation for the summary of benefits and coverage. But that doesn’t mean the NAIC’s work is done when it comes to ACA implementation. Because the law assumes that states will maintain their traditional role as the primary regulators of health insurance, the NAIC is facilitating that on a number of fronts, including:

  • Developing a set of ACA- related Frequently Asked Questions (FAQs) for Department of Insurance consumer support call centers;
  • Developing a framework for states to use in conducting market oversight of health insurers;
  • Assessing whether exchange navigators and others providing consumer assistance need Department of Insurance (DOI) oversight, licensing or credentialing; and
  • Reviewing existing model state laws to assess whether they should be deleted, retained or revised to comport with the ACA’s insurance reforms.

It is this last activity that was the subject of a NAIC working group call yesterday. Drafting and adopting model state insurance laws have been core functions of the NAIC for over a century. These model laws are often used by states as the template for their own legislation. Some states enact some models in their entirety; others make changes to reflect the unique needs of their markets or a particular regulatory approach.

Over time, the NAIC has adopted scores of model laws related to the regulation of health insurance. In Houston, a working group of the NAIC’s Health Committee (called the “B” Committee) initiated the daunting task of reviewing 31 of these models to assess whether any ACA-related changes are needed. This is an important job because many of these models contain provisions that have been either preempted by or are inconsistent with the ACA; other models have simply been made moot. To the extent states have conflicting law on their books, it complicates the efforts of insurance regulators to provide market oversight and ensure consumer protections are fully enforced.

The issues covered in these models are wide. For example, on yesterday’s call we reviewed models relating to premium rate review, external appeals, provider credentialing, and the establishment of consumers’ rights to a conversion policy (policies that may be offered after someone exhausts COBRA coverage or, in some states, in place of COBRA).

In preparation for yesterday’s call, which included consumer and insurance industry representatives, state regulators reviewed the existing model laws and made recommendations about whether they should be kept as-is, updated to reflect the changes wrought by the ACA, or deleted as no longer relevant. For example, there was broad consensus that the model law addressing conversion privileges should be deleted because the ACA’s requirement that insurers guarantee issue a policy to all applicants, without pre-existing condition exclusions, provides greater protections than states’ conversion laws. Other models will be kept, but with modifications to reflect ACA requirements.

The work group will hold more calls to go through all 31 models. Once they’ve completed their assessment of which models need updating, they will then start the hard work of actually amending the models. CHIR faculty will continue to monitor this effort so stay tuned to CHIRblog for future updates.

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  1. Pingback: Health Plans Get Creative Skirting the ACA - CCF - Center For Children and Families

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