Health News

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. (April 20, 2012)
The Health Practice Council submitted a comment letter to the Center for Consumer Information and Insurance Oversight (CCIIO) providing responses to questions raised during a meeting with representatives of CCIIO on the structure of a proposed actuarial value calculator (for purposes of the ACA). The letter addresses cost-sharing inputs for the calculator, incorporation of induced demand, number of geographic pricing tiers, and incorporation of multiple network tiers. (April 2, 2012)
The Academy filed on Jan. 27 an amicus curiae brief with the U.S. Supreme Court in the pending challenge to the Affordable Care Act. The court will hear oral arguments in March. The brief addresses a very narrow aspect of the case before the court—the severability of the individual mandate from the other market reform provisions, namely guaranteed issue and modified community rating. The brief does not take a position on the constitutionality of the individual mandate or whether any other provisions in the law are severable from the mandate—nor does it support or oppose the law as a whole. Read the brief. Read the Academy’s member alert on the filing. Read the news release. (January 27, 2012)
You can order your copy online or by mail/fax. The manual is designed to help appointed actuaries comply with the requirements of the NAIC model Standard Valuation Law and the Model Actuarial Opinion and Memorandum Regulation.  (January 20, 2012)
In December 2011, the Department of Health and Human Services published final regulations implementing the medical loss ratio requirements in the ACA. Insurers have already begun complying with the reporting and rebate requirements under the ACA and this webinar will focus on the implications of the changes in the final regulations. Learn more. (January 17, 2012)
The Academy’s Health Practice Council will present a webinar on Feb. 10 to provide actuaries from all practice areas with essential background on the Affordable Care Act (ACA), including key provisions in the law (focusing on those intended to expand coverage and the status of implementation). Members are invited free of charge. Learn more.  (January 11, 2012)
The Medicare slide decks—the first topic to be addressed in the Academy’s Campaign 2012 Toolkits series—include an overview of the structure of Medicare, the challenges to the program’s solvency and sustainability, and options that have been proposed to reform the program. You can download these files here: (December 23, 2011)
The Academys Pension Accounting Committee and Joint Committee on Retiree Health submitted a comment letter to the National Association of Insurance Commissioners (NAIC) on the exposure drafts of Statements of Statutory Accounting Principles (SSAP) No. 92 and No. 102. These exposure drafts are intended to replace existing standards governing accounting for pension benefits and postretirement benefits other than pensions (OPEBs). (December 9, 2011)
The Academy is creating toolkits designed to provide actuaries in every practice area with the tools necessary to deliver objective information on public policy issues to their own communities. The first in this series of toolkits is on Medicare’s financial condition. The toolkit includes a slide deck that provides an overview of the structure of Medicare, the challenges to the program’s solvency and sustainability, and options that have been proposed to reform the program. Learn more
(November 23, 2011)
The Health Practice Council co-signed a letter with the Committee on Qualifications to the Arizona insurance director pointing out that their regulatory definition of “qualified actuary” for health premium actuarial certifications was inappropriate and suggested corrective language. (November 18, 2011)
The Academy’s Cancer Claims Cost Tables Work Group submitted a letter to the NAIC’s Health Actuarial Task Force (HATF) indicating progress it has made over the last year and informing HATF of what it intends to do in the coming year. (November 11, 2011)
The Academy’s Group Long-Term Disability Work Group provided an update to the NAIC's Health Actuarial Task Force (HATF) at the NAIC’s Fall Meeting highlighting progress on the Long-Term Disability Valuation Table as well as indicating what work still needs to be completed.  (November 11, 2011)
The Premium Review Work Group sent a letter to the Mass. Senate regarding an amendment to the state budget that would require the disapproval of any health insurance rates to be “supported by sound actuarial assumptions and methods.” (November 1, 2011)
A joint work group comprised of members of the SOA Long-Term Section Council and the Academy’s Federal Long-Term Care Task Force submitted a letter to HHS Secretary Sebelius regarding the department’s extension of the Genetic Information Nondiscrimination Act (GINA) to long-term care insurance in proposed regulations.  (October 13, 2011)
Exchanges Work Group comments to CMS in response to proposed regulations establishing health insurance exchanges and qualified health plans under the ACA.  (October 6, 2011)
The Academy recently sent a letter to the NAIC Medigap PPACA Subgroup offering comments on the subgroup’s new discussion paper, Medicare Supplement Insurance First Dollar Coverage and Cost-Shares. (October 4, 2011)
The Academy recently sent a comment letter to the members of the new Joint Select Committee on Deficit Reduction urging action to improve the long-term solvency and sustainability of the Medicare program.  (August 31, 2011)
The Academy/SOA Long-Term Disability Work Group gave an update to the NAIC's Health Actuarial Task Force on the work group's progress regarding the creation of a valuation table for group long-term disability. The work group expects the table to be completed by March of 2012.  (August 31, 2011)
The Academy's Medicare Supplement Work Group sent a letter to the NAIC's Medicare Supplement Refund Formula Subgroup with a proposed charge to have the work group review the Medicare Supplement Refund Formula for potential changes that may need to be addressed.  (August 31, 2011)
The Academy's Medicaid Work Group presented to the Centers for Medicare and Medicaid Services (CMS) on the Medicaid rate-setting process for Medicaid Managed Care programs. The presentation included a discussion about base data sources, base data adjustments, risk adjustment, risk-sharing arrangements, and performance incentives.  (July 21, 2011)