State health insurance commissioners said they are working fast and furiously to complete definitions and recommendations to HHS so the agency can draft hotly anticipated rules on how health plans can spend premium dollars.
States race to supply insurance recommendations
The commissioners said they want to make sure that the rules encourage quality and innovation while holding insurers accountable. “If we are going to get costs under control without degrading quality, we have to encourage quality improvement initiatives,” said Sandy Praeger, Kansas insurance commissioner.
Praeger and other insurance commissioners spoke to reporters during a meeting of the National Association of Insurance Commissioners in Washington.
Under the health reform law, starting in 2011, health insurers must spend at least 85% of subscriber premiums on medical costs in group coverage plans, and at least 80% for individual plans, according to the Patient Protection and Affordable Care Act.
Quality-improvement initiatives can be included in this so-called medical loss ratio, but some provider groups are pressing the NAIC and HHS to allow only very specific quality programs that directly improve a patient's outcome in this calculation.
But Praeger seemed to disagree, saying that some broad-based insurer programs, such as nurse hotlines, can improve quality and reduce costs. “Many aspects to nurse hotlines are about making sure people get the care they need,” she said. The commissioners added insurers will have to demonstrate that these programs produce results.
The NAIC has until Dec. 31 to give HHS recommendations on this rule, but NAIC officials said they hope to have them completed by August or September.
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