The NAIC’s Summer Meeting: Updating Network adequacy and ACA Transparency Requirements

Last month, I attended the National Association of Insurance Commissioners’ (NAIC) summer meeting in Chicago as a consumer representative. Outside the meeting hall, the Blue Angels thundered overhead and Idina Menzel belted out “Let It Go” in Millenium park, but inside the hall, it was a relatively quiet meeting. That’s because the two areas of work that are of particular interest to health policy followers have been taking place in regular, twice-weekly calls in the committees: updates to the network adequacy model act and recommended changes to the Summary of Benefits and Coverage (SBC).

Network Adequacy Model Act: As we updated in an earlier CHIRblog post, the Network Adequacy Model Review Subgroup has been plugging away at revisions to this nearly two-decades-old model act governing network adequacy standards for state-regulated plans.  The work group had hoped to have an update to share at the August meeting, but they just missed that deadline. A revised version was posted September 1st and is open for comments until September 22nd. The subgroup has asked that comments be limited to technical changes – those needed to ensure the language accurately reflects the discussions to date – not substantive changes to the model act. But there will be more opportunities for advocates to weigh in as the model act moves through the NAIC approval process. Following comments on the exposure draft, the subgroup will convene on calls again to finalize the draft. Once cleared by the subgroup, the model act will move to the Regulatory Task Force for consideration, then to the Health Insurance and Managed Care (B) committee, and onto the Executive Plenary committee for final approval.

NAIC consumer representatives have been regularly participating in the calls along with representatives of provider groups, health plans, patient groups, and regulators to hammer out line-by-line revisions to the model act. Along the way, consumer representatives have gained improvements, including new language that would address an issue that is gaining more attention: balance billing, in which consumers are hit with surprise charges when they inadvertently get care out-of-network.

Updates to the Summary of Benefits and Coverage: Another of the “B” committee work groups, the Consumer Information Subgroup, has been working on recommendations for changes to the SBC template.  Work there began soon after HHS published a FAQ on the SBC in March, inviting the NAIC and others to provide comments on needed changes to the template.  As we noted in an earlier post, the challenge has been to balance the need to provide adequate and clear information for consumers comparing plan options and using their benefits with the need to keep the form at a manageable number of pages. After consumer testing on changes discussed by the subgroup, the work group will make final recommendations to HHS in time for final federal rules expected before 2016.

In the months ahead, the B Committee’s ERISA Working Group will be considering updates to the ERISA handbook to capture Affordable Care Act changes affecting employer-sponsored coverage, and the Health Care Reform Regulatory Alternatives Working Group will take a closer look at state options under Section 1332 waivers. Check back here for updates on that work and, hopefully, the final steps on SBC and network adequacy revisions at the NAIC!

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