In its draft white paper on decisions suggested for states now subject to a Federally Facilitated Exchange (FFE), an NAIC Working Group suggests that these states may want to consider entering into an enforcement arrangement with the Department of Health and Human Services (HHS) to clarify the role of the state insurance department.
The Health Care Reform Regulatory Alternatives Working Group, now chaired by Wisconsin Insurance Commissioner Ted Nickel and composed of 26 jurisdictions, notes in the draft paper that many of the market reforms in the Affordable Care Act (ACA) will be primarily enforced through the form review process.
Apparently, the March 1 HHS draft letter to issuers said that for the 2014 coverage year, when CMS is evaluating applications for QHP certification, CMS will rely on state analyses and recommendations when the state has the authority and means to assess issuer network adequacy, the draft paper noted. However, CMS will watch things closely, according to the letter.
The letter indicates, the working group interpreted, that CMS will monitor network adequacy in various ways, including via complaint tracking or gathering network data from any QHP issuer “at any time to determine whether the QHP’s network(s) continues to meet these certification standards.”