Letter Regarding Appropriate Definition of Qualified Actuary As It Relates to ACA's Rate Review Provision

The Health Practice Council and the Committee on Qualifications sent a letter to all state insurance commissioners and chairs of each state house and senate insurance committee regarding the appropriate definition of "Qualified Actuary" as it relates to the Affordable Care Act's rate review provision. Under the Affordable Care Act, the Centers for Medicare and Medicaid Services (CMS) is authorized to determine whether health insurance rate increases filed with states are “unreasonable.” As of September 1, 2011 rate increases equal to or greater than 10 percent may be reviewed by states that have been determined by CMS to have an effective rate review program; otherwise, increases in excess of 10 percent will be reviewed by CMS to determine whether such rate increases are “unreasonable.” As a result, many states are in the process of drafting regulatory language that would create their own rate review program. In the past few months, an inconsistency in the definition of “qualified actuary” in some state regulations has come to the attention of the American Academy of Actuaries. The letter provides recommended language regarding the appropriate definition of qualified actuary as states move to implement the Affordable Care Act’s rate review provision.