The Blue Cross and Blue Shield Association (BCBSA) told an NAIC Exchanges subgroup that it agrees with its proposal to separate marketing and consumer information into two distinct sections but strongly advised that the NAIC not go further than the health care reform act requires.
The final rule from the Centers for Medicare and Medicaid Services (CMS) defers to existing state laws, the BCBSA told the NAIC Exchanges Subgroup’s Marketing and Consumer Information Team.
“We caution against [the NAIC] applying the Medicare Advantage rules for marketing in the exchanges because the states will play a considerable role in overseeing exchanges,” the BCBSA said in its comment letter May 24 to a draft paper on marketing and consumer information.
The letter was issued in advance of a team conference call May 31.
CMS does not provide specific criteria for marketing requirements under federally facilitated Exchanges and the Patient Protection and Affordable Care Act (PPACA) doesn’t require states to apply the same marketing requirement outside an exchange even if a state elects to establish new standards for exchanges, noted the letter, signed by David Korsh, BCBSA director of state services.
The letter revealed that it is unclear to the industry what the NAIC’s need was in the purpose and scope of its white paper on marketing and consumer information.
The white paper should clearly state up front that its purpose is to identify insurance department best practices to state oversight and compliance in those area with the PPACA, the letter said.
The draft paper states that its purpose is to explore issues and options for implementation of certain provisions of the law and regulations having to do with navigators, agents and brokers, summary of benefits and coverage and marketing......”Where possible, this paper will highlight these situations and possible differences in approach, including issues that implicate the involvement of the Departments of Insurance,” the draft states.
Moreover, the summary of benefits and coverage in the white paper should be under "consumer Information," not in a separate section, the letter said.
The letter went on to stress that it believes the Navigator role in the Exchanges should be a regulated entity or person overseen by state insurance departments,and not a physician, a provider wit ha contractual interest or anyone else wit ha conflict of interest. PPACA already precludes health insurers from being Navigators.
PPACA and its regulations state that the Exchange must select entities from at least two of a cluster of categories (including a commercial fishing industry organizations, ranching and farming organizations) to serve as Navigators; and one of the two must be a community and consumer focused nonprofit group.
Navigator candidates need to be carefully screened and selected to ensure that they have the necessary capacity and connections to the targeted communities, stated the NAIC Consumer Liaison Representatives in a comment section to the NAIC draft white paper.
“A model that may work well is that done by the Community Services Society of New York. CSSNY has a consumer assistance grant from the State of New York. It contracts with multiple smaller organizations that relate to specific populations, including small employers and supervises those organizations,” the consumer reps told the NAIC.
America’s Health Insurance Plans (AHIP) said in its letter to the Team that, in addition to ensuring no conflicts of interest, it urges consideration of how such Navigator compensation will work.
“We anticipate, for example, that consumers will be contacting navigators often, and sometimes speaking to different Navigators as they learn more about exchanges or begin to attempt to make a plan selection,” AHIP wrote in a May 24 letter signed by Candy Gallaher, Senior Vice President AHIP State Policy.
So, if Exchanges use a “based on number of people helped” metric to determine compensation, it is very possible that compensation could be driven up. An alternative would that the Nnavigator who provides for the successful enrollment, would be compensated, eliminating the possibility for multiple Navigator compensation for a single enrollee, AHIP stated.
AHIP also said it believes states should consider identifying and tracking when an Agent or Broker is acting as a Navigator. “We recommend that Agents and Brokers acting as Navigators should undergo the same training and receive the same compensation as Navigators. There is also the requirement that Navigators be non-profit, which may limit the ability of a licensed agent or broker to become a Navigator,” AHIP stated.
The NAIC has five teams working on Exchanges' plan management functions and these five teams are trying to develop "white papers" soon, plowing ahead, even, as one lobbyist noted though half of the NAIC member states seem to be unwilling or reluctant to get engaged too substantively and uncertainty around the PPACA’s status swirls.
Christie says the state should wait until the U.S. Supreme Court rules on the constitutionality of the federal Patient Protection and Affordable Care Act of 2010 (PPACA) before moving ahead with efforts to create an exchange.
However, if it is upheld and states are not ready, these states are morel likely to have a greater degree of federal oversight in their plans, through a partnership or a fully federal Exchange.
The Patient Protection and Affordable Care Act of 2010 (PPACA) calls for federal and state agencies to set up state-based health insurance exchanges, or Web-based insurance supermarkets, that will sell coverage to individuals and small businesses.
States can choose whether to run their own exchanges, participate in multi-state exchange consortiums, or let the federal government provide exchange services for their residents.
Allison Bell contributed material to this report