Milestone: Conduct a statutory and regulatory analysis of what is required to bring the state into compliance with federal law
An important initial step in effective market regulation is for each state to analyze which of its laws and regulations need to change in order to implement the insurance related provisions in the ACA.
*Full name: Conduct a statutory and regulatory analysis of what is required to bring the state into compliance with federal law.
*Relevance to the ACA:
The ACA contains a number of provisions affecting commercial insurance, especially the individual and small group markets. Relevant sections include:
§1001- Enacts individual and group market reforms effective for plan years after September 2010. These reforms include:
-- Prohibits lifetime or annual limits and rescissions.
-- Provides guaranteed issue for children and extension of dependent coverage.
-- Requires coverage of preventive services and emergency services, access to pediatric care and to OB/GYN care, and choice of provider.
-- Provides reporting requirements for plans, standardized definitions of insurance-related terms and explanation of coverage, and standardized medical loss ratio.
§1003 - Creates a premium rate review process beginning in plan year 2010 and requires plans to justify an unreasonable rate increase to the state and the Secretary of HHS.
§1201 - Applies additional consumer protections to large and small group markets and the individual market beginning 2014 including:
-- Prohibits rating by health status and exclusions of pre-existing conditions.
-- Establishes maximum premium rating bands and limits rating factors to age, tobacco use, area, and individual or family status.
-- Prohibits excessive waiting periods.
-- Guarantees coverage availability and renewability.
-- Establishes minimum benefit standards.
§1251 - Creates grandfathered plans, which will be subject to only a select number of insurance reforms. Final regulations issued (75 FR 34540) limit changes plans can make and still retain grandfathered status.less