HealthCheck, April 2016

In this issue: Recap of Academy activities, new regulatory updates, and LHQ Seminar

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April 13, 2016

Academy Activities

The Health Solvency Subcommittee sent a letter March 28 to the NAIC’s Health Risk-Based Capital (E) Working Group with comments on Proposal 2016-01-H’s individual premiums and claims footnote.

The Academy held a March 30 webinar, “A Conversation with CCIIO on 2017 Rate Filings,” at which attendees from about 570 registered sites had the opportunity to engage with representatives of the Center for Consumer Information and Insurance Oversight (CCIIO) as they provided a live demonstration of the unified rate review template (URRT) in light of the new 2017 rate filing instructions and changes. Members may log in to hear an audio recording of the webinar.

Also on March 30, the Premium Review Work Group sent a letter to CCIIO with comments on the 2017 URRT and instructions.

Several groups under the Academy’s Health Practice Council made presentations at the NAIC Spring 2016 National Meeting in New Orleans earlier this month:

  • The Risk Sharing Subcommittee presented an update to the Health Actuarial (B) Task Force (HATF) on its report about the risk adjustment program.

  • The Long-Term Care (LTC) Principle Based Reserve (PBR) Work Group presented its final report to the NAIC’s LTC Actuarial (B) Working Group.

  • The LTC Credibility Monograph Work Group also presented an update to the NAIC’s LTC Actuarial (B) Working Group.

  • The Cancer Claim Cost Table Work Group presented to HATF on its progress in updating the 1985 cancer claim cost tables.

Legislative/Regulatory Updates

check markCMS released a white paper on March 24 that summarizes the risk adjustment program under the Affordable Care Act (ACA) and outlines potential modifications to the methodology for 2018 and beyond. The white paper cites analysis from the Academy issue brief Risk Assessment and Risk Adjustment regarding the relationship between medical diagnosis and treatment costs. Comments are due by April 22.

check markOn April 5, the Centers for Medicare and Medicaid Services (CMS) announced 2017 calendar year capitation rates for Medicare Advantage plans.

check markCMS issued a final rule March 30 addressing the application of mental health parity requirements to Medicaid managed care organizations.

check markOn March 11, CMS published a proposed rule regarding the implementation of a new Medicare Part B Drug Payment model to test whether alternatives drug payment designs would reduce Medicare spending while preserving quality care. Comments are due by May 9.

In the News/Media Activities

The Academy’s analysis of options for implementing the ACA’s reinsurance program was mentioned in a story in The Hill. During the public comment period on the proposed rules for the program in 2014, the Academy’s Risk-Sharing Work Group submitted its analysis to CMS, stating that “the proposed rule would provide more certainty that the reinsurance payments will be fully funded and may result in insurers more fully offsetting premiums by anticipated reinsurance payments.” A Daily Kos column also referenced the Academy’s analysis on the ACA’s reinsurance program.

The Academy Risk Sharing Subcommittee’s presentation on risk adjustment at the NAIC Spring 2016 National Meeting was posted on

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