Implementation: Advocates' To Do List
Other Reforms to Watch
That Go into Effect Later This Year
Rescissions (Section 1001 of the Patient Protection and Affordable Care Act, Section 2301 of the Health Care and Education Reconciliation Act of 2010; Creates Section 2712 of the Public Health Services Act): The federal health reform law protects against unfair rescissions of health plans, which typically occur only after an enrollee submits expensive claims for care. The law states that rescissions may occur only in cases of fraud or intentional misrepresentation and that insurers must provide advance notice to policyholders if they intend to rescind their plans. Your state can enact a clear appeals process for consumers to use if they get such a notice and disagree with the rescission.
Internal and External Appeal Rights (Section 1001, as amended by section 10101, of the Patient Protection and Affordable Care Act; Creates Section 2719 of the Public Health Services Act): Under health reform, health plan enrollees have a right to both internal and external appeals of claim and coverage denials. At a minimum, the external appeals process must comply with the standards in the National Association of Insurance Commissioners (NAIC) model law for external appeals. It also must provide culturally and linguistically appropriate notice of appeals, and it must provide enrollees who are making appeals with the opportunity to present testimony and evidence to support their case. If your state does not currently have an external appeals process that meets these standards, you can work to improve it.
Web Portal for Identifying Coverage Options (Section 1103, as amended by section 10102, of the Patient Protection and Affordable Care Act): Starting on July 1, 2010, consumers in all states will be able to identify their options for insurance coverage on a new website developed by HHS. The website will showcase several options, including private insurance, Medicaid, CHIP (the Children's Health Insurance Program), and high-risk pools. In addition, it will provide information on the small business tax credits and reinsurance for retiree health coverage. You have an opporyies to provide input to HHS on the new Web portal so that it will best serve consumers in your state: HHS has now issued an interim final rule for the new portal. Public comments for this rule are due on June 4, 2010, by 5:00 pm.
The Department of Health and Human Services, together with other federal agencies, will be promulgating regulations and guidance on a number of reforms this year. Watch for opportunities to comment on the rules for the following:
- Allowing young adults to stay on their parents’ insurance plans until age 26;
- Restrictions on annual limits on benefits;
- Prohibitions on pre-existing condition exclusions for children;
- Protections against higher cost-sharing for out-of-network emergency care;
- Access to pediatricians and women’s health providers;
- Minimum medical loss ratio requirements;
- Transparency in health insurance data;
- Closing the Medicare Part D doughnut hole; and
- Changes to Medicare Part D rules that are designed to reduce the number of low-income beneficiaries that are forced to change plans each year.
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