LEG REG REVIEW is a periodic newsletter produced by PHILLIPS ASSOCIATES, a professional lobbying and consultant firm located near the State Capitol. It contains news on the legislative and regulatory scene in Pennsylvania that may be of interest to the Insurance and Business Communities. It is a free member benefit for those who are members of the Pennsylvania Association of Health Underwriters (PAHU) or Manufacturers Association of South Central PA (MASCPA). Subscription information may be obtained by contacting PHILLIPS ASSOCIATES at 717/728-1217 FAX 717/728-1164 or e-mail to firstname.lastname@example.org. Please email email@example.com supplying both your name and e-mail address if you wish to be removed from this list.
NAIC CONSIDERS MLR ISSUE
On November 22, the National Association of Insurance Commissioners (NAIC) convened a teleconference to discuss and vote on a resolution seeking to exempt agent compensation from the company calculation of the Patient Protection Affordable Care Act (PPACA) Medical Loss Ratio (MLR). Pennsylvania’s Insurance Department’s vote was for the resolution. This was a milestone vote by the commissioners in favor of the agents’ position. This was NAHU’s top regulatory priority. Those wishing to send a thank you note may do so to:
Hon. Michael Consedine
PA Insurance Commissioner
1326 Strawberry Square
Harrisburg, PA 17120
CORBETT ADMINISTRATION TO PROPOSE EXCHANGE
After a considerable period, the Corbett Administration has decided to go ahead and propose legislation establishing a PA Health Insurance Exchange. Exchanges are part of the Patient Protection Affordable Care Act (PPACA) and states must enact enabling legislation by January 1, 2013 or they will be placed into an HHS Exchange now being constructed at the national level. Some speculation was that the Administration was waiting to see what direction the courts would take before initiating any action. Another scenario is that the Insurance Department was researching and laying the groundwork for the legislation pending final approval from the Governor’s Office. Thus far, the Department commissioned consulting firm KPMG to study the exchanges tried in other states and present analysis of various models. This grant work was released November 21 and is available on an Insurance Department web site, www.PAHealthOptions.com. The web site also has links to all of the testimony from the three Insurance Department hearings back in August.
Right now, legislative language from the Insurance Department is not ready for final internal approval before being released. In a related development, the Insurance Department is seeking a grant from HHS to help PA design software for an Exchange-type referral system.
NAHU EARLY BIRD EXPIRES DECEMBER 8
The Early Bird rate for those wishing to register for the Capitol Conference in Washington, DC January 23-25, 2012 need to contact the National Association of Health Underwriters at www.nahu.org . That web site also links to the hotel site (Hyatt Regency Washington on Capitol Hill).
LINDA BEBKO-JONES DIES
Former Representative Linda Bebko-Jones has passed away. The former Erie legislator served for 14 years until her retirement in 2006. Personal note: Linda was a passionate fighter for the little guy and a long-standing member of the House Insurance Committee.
HOUSE INSURANCE COMMITTEE PLANS HEARINGS
The House Insurance Committee scheduled two hearings for the last week of November. First is a November 29 hearing on House Bill 1763 (Miccarelli-R-Delaware) on physician contracts with health insurers. The bill would provider greater transparency regarding insurer fee schedules, spell out fee notification rules by carriers to health care providers, and give providers a 65-day window to protest from the original notification date of the change. HB 1763 also promotes additional transparency in claims payment practices, requires that health care providers exhaust internal company appeals first in the event of a disputed payment and gives them a 90-day window to begin formal dispute procedures.
A second hearing takes place November 30 on House Bill 1561 (Cutler-R-Lancaster) on physician credentialing by health insurers. HB 1561 would require health insurers to decide on a physician application for credentialing within 60 days. It also establishes appeal procedures and what grounds the physician may seek an appeal from a health insurer rejection of a credentialing application.
FLOOD CLAIM UPDATE
- On November 23, FEMA announced that PA victims of Hurricane Irene and Tropical Storm Lee have been given extra time in order to file proofs of loss (FEMA Notice W-11120 November 22, 2011). This 60-day extension is the second extension given by the Federal Emergency Management Agency. The new date is January 23, 2012. These losses are those that were experienced between August 26- September 4, 2011. Details: James Sadler, NFIP Director of Claims (JamesSadler@dhs.gov) .
- FEMA and PEMA declared that certain private nonprofit organizations may be eligible for disaster assistance for losses suffered during Irene and Lee providing they meet qualifying conditions under the federal Public Assistance Program. If approved, funding may be conditioned on the percent of the facility dedicated to public use. Private nonprofit organizations must have suffered over $1,000,000 in damage. Details: FEMA Release 4025-12 November 18, 2011 http://www.fema.gov/news/release.fema?id=59585
HHS SLAMS MENNONITE INSURER
On November 21, the Department of Health and Human Services hit a Mennonite health insurance plan for exceeding ten percent in seeking a rate approval. Everence increased Pennsylvania small group rates by 12 percent effective October 1, the first increase in over two years. HHS based its determination that the rate request was “unreasonably high” on the authority it assumed under the Patient Protection Affordable Care Act (PPACA). The Goshen, Indiana-based insurer countered HHS’ charge by stating that its state experience data for Pennsylvania matched its national experience data for a two-year period. PAHU issued a statement to some trade press saying that HHS clearly demonstrated why PA’s General Assembly needed to pass rate review authority by the PA Insurance Department (SB 1336 and HB 1983) to “try to keep HHS’ nose out of our business”. PAHU also noted that Mennonites don’t have a history of ‘ripping each other off’ in trying to protect their church members and congregations.
GOVERNOR SIGNS BILLS INTO WITH SOME INSURANCE EFFECT
On November 22, Governor Corbett signed these bills into law as Acts 103 and 106 of 2011 respectively.
- House Bill 563 (Geist-R-Blair) creates an exemption from liability for a landowner who allows for the use of his/her land for an approved motorcycle safety program.
- Senate Bill 834 (Eichelberger-R-Blair) revises and updates bond or crime-fidelity insurance requirements for county officers and employees having responsibility for money or property. Because of the involved nature of the legislation, a link follows: