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 email@example.com. Please email firstname.lastname@example.org supplying both your name and e-mail address if you wish to be removed from this list.
GENERAL ASSEMBLY NOTE: The House and Senate will reconvene on March 26.
HHS ISSUES RULE ON EXCHANGES
On March 12, the US Department of Health & Human Services issued a Rule concerning the parameters under which states may set up Health Insurance Exchanges. Stressing that states must comply with the Patient Protection Affordable Care Act (PPACA) but are able to have discretion in how they are established. Examples of this state discretion would be whether the Health Information Exchange is a new government entity or works through an established agency such as the Insurance Department and of course what role insurance producers and Navigators have in the new program. In PA, the Corbett Administration has not yet finalized its actual language but says that it will be very soon. On March 9, the Insurance Department opted not to testify before a House Insurance Committee that would have taken place March 14 because HHS’ guidance regarding the $33 million implementation grant was unclear and because the Corbett approach had not completely jelled.
For a summary of HHS’ Exchange rule issued March 12, please link here:
The link to the actual document follows: http://www.ofr.gov/OFRUpload/OFRData/2012-06125_PI.pdf
When referencing the 644 page document, note that HHS’ reaction to the than 24,780 comments appears first followed by the actual text of the Rule towards the end. One caveat is that HHS puts in the changes but does not include original Rule text that was unchanged after the comment period. This may pose difficulty in cross referencing the previous Rule proposed and this one with the final changes. Some reference points are: Navigators starting on Page 79; Agents on Page 94.
Link to the earlier July 11, 2011 HHS draft of the Rule appears below.
NOTE: Abortion controversy also came from reaction by some right to life groups and blogs that said that last week’s Exchange Rule mandated a $1.00 fee to fund abortion coverage. The issue is the “pre-regulatory model guidelines on segregation of funds published by the Office of Management and Budget.” Neither the new Rule nor the July 11 draft explicitly referenced the concern. If you have any insight on this issue, please email email@example.com.
HHS ANNOUNCES MEDICAID RULE MARCH 17
In preparation of the expansion of Medicaid to 133 percent of the Federal Poverty Line in 2014 because of the Patient Protection Affordable Care Act (PPACA), the Department of Health & Human Services announced Medicaid eligibility and signup rules. The Rule is designed to facilitate enrollment in Medicaid and CHIP as it links up with the Health Insurance Exchanges.
Currently, the Federal Poverty Level is $14,856.00 for an individual (with the Medicaid threshold in 2014 to be $19,758.00) and for a family of four, the FPL is $30,656 now with Medicaid eligibility to be $40,772.00 in 2014. That is based on today’s FPL. By 2014, the FPL baseline will doubtless increase. The Kaiser Family Foundation estimates that currently, 12 percent of Pennsylvanians are on Medicaid.
A link to the HHS fact sheet appears below.
MORE HHS PPACA RULES
- Sure to evoke more controversy, HHS issued an Advance Notice for Final Rulemaking on women’s reproductive services that must be paid 100% by health insurers (first-dollar coverage). This stemmed from an announcement last August that HHS had widened the PPACA definition of certain preventive services to include a wide range of women’s AIDS, STD, and abuse counseling, exams, treatments, sterilization, and contraceptives that are FDA approved. This last item is what caused such a political firestone since religious groups’ employees and employees of health care facilities run by religious groups would be forced to provide this coverage. The Obama Administration tried to dispel the furor by saying insurers could absorb the cost directly so as to allow religious entities the ability to say that they are not providing this coverage. Some conservatives called it an attack on religious beliefs and an attack on morals to have insurers forced to pay for a lifestyle which involves contraceptives. The Obama Administration and their advocates fired back to accuse the GOP of not allowing women to have contraceptives.
There is a ninety comment period and instructions on submitting comments are found using the link below. Following that link, the second link gives an overview from the Obama Administration on women’s preventive services.https://www.federalregister.gov/articles/2012/03/21/2012-06689/certain-preventive-services-under-affordable-care-act. ********
- A less controversial rule on how college health programs must be structured in order to comply with PPACA with the link appearing below.
- The Insurance Department hearing on Highmark’s acquisition of West Penn Allegheny Health System and application of “UPE” to acquire control of Highmark and its Pennsylvania insurance subsidiaries is set for April 17 in Pittsburgh at the Westin Hotel at the Convention Center. There will be two sessions, 9 to 5 and one starting at 7:00 p.m. Pre-registration is not mandatory but those who do will receive an advance copy of the agenda. Those wishing to testify are asked to submit comments in advance to Robert Brackbill 717/787-8557 firstname.lastname@example.org.
- First Sealord Surety’s liquidation has a March update regarding the collateral of the entity and the Insurance Department is attempting to get a better sense of the cash collateral which may have been extended by Principals. Principals should send documentation to: PA Insurance Department, Office of Liquidations, Rehabilitations & Special Funds email@example.com . FYI, the deadline for filing claims is October 5, 2012. Pennsylvania is NOT a state where the Guaranty Fund applies. A link to the Department’s web page on First Sealord Surety, Inc. follows: