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September 24, 2010

Academy Activities

The Academy's Benefits and Eligibility Work Group submitted a letter on Sept. 17 to the Department of Health and Human Services' (HHS) Office of Consumer Information and Insurance Oversight commenting on an interim final rule related to a requirement of the Affordable Care Act that preventive services be covered without cost sharing. The letter seeks clarification regarding the services that are covered and the frequency at which they are covered. The letter also examines the economic impact of first-dollar coverage of preventive services.

A letter submitted to HHS on Sept. 22 by the Academy's Risk Sharing Work Group offered input on Section 1341 of the Affordable Care Act, which tasks the Academy with providing recommendations to the secretary of HHS regarding the temporary reinsurance provision. The letter provides initial input on potential approaches for identifying high-risk individuals and determining reinsurance payments.


Legislative and Regulatory Updates

check markKey provisions of the Affordable Care Act went into effect Sept. 23. These provisions include:

  • Requiring plans that offer dependent coverage to allow young adults to remain on their parents' plan until the age of 26;
  • Prohibiting insurers from using information about preexisting conditions when selling insurance coverage to children;
  • Placing new restrictions on rescissions of policies;
  • Banning lifetime benefits limits and placing restrictions on annual limits;
  • Requiring first-dollar coverage of preventive services.

check markThe National Association of Insurance Commissioners' Patient Protection and Affordable Care Act Actuarial Subgroup has exposed a draft regulation on medical loss ratios. The draft regulation, to be submitted to HHS, promulgates uniform definitions and a standardized calculation methodology for rebates of health insurance premiums, as required under the Affordable Care Act. Comments are due by Oct. 4. A conference call to adopt the regulation is scheduled for Oct. 4.


In The News/Media Activities

An op-ed by Rep. Charles W. Boustany Jr. (R-La.) published by Human Events on Sept. 20 cited the Academy's concerns with the Community Living Assistance Services and Supports (CLASS) Act. These actuarial concerns were detailed by the Academy in a 2009 letter to the U.S. Senate Committee on Health, Education, Labor and Pensions. In his op-ed, Boustany discussed new legislation—the Fiscal Responsibility and Retirement Security Act (H.R. 5853)—that would require Congress to reexamine the CLASS Act.

In a Sept. 20 article in the North County Times, Academy Health Practice Council member David Shea discussed how several health care reform provisions that took effect on Sept. 23 will affect the health insurance market. Shea said that the prohibition on denying insurance to children with preexisting conditions would have the greatest effect and could put upward pressure on health insurance prices. He also noted that insurance companies are concerned about this provision because the law has no uniform, predefined enrollment period. Shea said that having a uniform enrollment period would help keep the overall cost of premiums down.

News links are to external websites. The Academy is not responsible for the content of these websites.