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State of Nevada Office for Consumer Health Assistance HEALTHCARE REFORM Marilyn G. Wills, Director Governor’s Consumer Health Advocate.

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Presentation on theme: "State of Nevada Office for Consumer Health Assistance HEALTHCARE REFORM Marilyn G. Wills, Director Governor’s Consumer Health Advocate."— Presentation transcript:

1 State of Nevada Office for Consumer Health Assistance HEALTHCARE REFORM Marilyn G. Wills, Director Governor’s Consumer Health Advocate

2 Office for Consumer Health Assistance  Workers Compensation Ombudsman 2001 Legislation  Senate Bill 573 – Transferred Bureau for Hospital Patients to GovCHA  Hospital billing issues  Jurisdiction: Final determination (NRS )

3 Office for Consumer Health Assistance  Assembly Bill 236 – Nevada Prescription Help Desk RxHelp4NV.org  Assembly Bill 79 – External Review ◦ Certified by Division of Insurance ◦ Final Determination 2005 Legislation  Assembly Bill 155 – Requires all Nevada Hospitals to have GovCHA contact information on all Admission and Discharge forms. (NRS )  Post discount policy for uninsured.

4 Office for Consumer Health Assistance  Senate Bill 126 – Requires the Division of Industrial Relations (DIR) to include GovCHA contact information on all notices or forms sent to an injured employee. These include: ◦ C1 – Notice of Injury or Occupational Disease ◦ C3 – Employer’s Report of Industrial Injury or Occupational Disease ◦ C4 – Employee’s Claim for Compensation/Report of Initial Treatment ◦ D1 – Workers’ Compensation Rights and Benefits Poster ◦ The DIR’s web-site

5 Office for Consumer Health Assistance  Five years  Assist small employer and their employees in resolving disputes with insurance companies relating to insurance coverage, claims, payments, and reimbursements  Small business employer education and advocacy  Small group health plans  Health Care Reform

6  Provision in the Patient Protection and Affordable Care Act of 2010 (Health Care Reform)  Strategic Collaborations ◦ Access to HealthCare Network ◦ SHIP ◦ RAGE ◦ Salud En Accion Goal is to expand the reach of the office and assist more individuals statewide

7 2011 – AB519  Moved GovCHA to DHHS, Director’s Office  Transferred Office of Minority Health from the Health Division to GovCHA – remains as separate program  Nevada 211 moved under GovCHA umbrella  Established GovCHA Director as “Governor’s Consumer Health Advocate” Office for Consumer Health Assistance

8  Expands rules for External Review  Establishes Silver State Exchange

9 HEALTH CARE REFORM Patient Protection and Affordable Care Act Signed into Law March 23, 2010 Health Care and Education Affordability Reconciliation Act Signed into Law March 30, 2010 Created to improve access to health insurance and improve overall quality and affordability for all Americans. Office for Consumer Health Assistance

10 HEALTH CARE REFORM Insurers that offer dependent coverage must offer coverage for adult children until age 26, EVEN IF... no longer lives at home; Is not claimed as a dependent, or; Is no longer a student Effective September 23, 2010 Office for Consumer Health Assistance

11 HEALTH CARE REFORM Insurance plans can no longer charge co- pays/deductibles for preventive care screenings (ex: cancer, cholesterol, diabetes) Grandfathered plans are exempt Insurers cannot deny coverage to children through age 18 that have pre-existing conditions. Grandfathered “Individual” plans are exempt from this provision Office for Consumer Health Assistance

12 HEALTH CARE REFORM Insurers cannot require higher co- payments/deductibles if the member seeks treatment at an out-of-network emergency room Grandathered plans are exempt. Insurers are prohibited from setting dollar limits on the lifetime of the policy; and annual limits on essential benefits are greatly restricted. All plans are affected. Office for Consumer Health Assistance

13 HEALTH CARE REFORM Pre-Existing Condition Insurance Plan Provides health care coverage to individuals with pre-existing conditions. Apply at eligibility requirements:www.pcip.org  Must be a U.S. Citizen or legal resident;  Must not have had coverage under another plan for 6 months prior to applying;  Must have been denied coverage by an insurer within the last year because of pre-existing condition, (denial letter). Office for Consumer Health Assistance

14 HEALTH CARE REFORM Early Retiree Insurance Plan Provides continued health care coverage to individuals who retire early but are not yet eligible for Medicare (ages 55-64) Apply through employer’s group plan Small Business Tax Credit 25 or less employees If eligible, may receive up to 35% tax credit Office for Consumer Health Assistance

15 HEALTH CARE REFORM What is a “Grandfathered” Plan? If a plan was in existence before reform was enacted on March 23, 2010 it is considered to be a “grandfathered” plan. Plans are allowed to keep their grandfathered status as long as they do not make any significant changes in coverage. For example:  Significantly increases premiums;  Increase medical costs to employees;  Reduces the employer contribution;  Significantly cuts or reduces benefits;  Adding or tightening an annual limit The plan loses its grandfathered status and is subject to the provisions in the Health Care Reform Act if any of the above take place. Office for Consumer Health Assistance

16  7- Member Voting Board  Governor appoints 5  Senate Majority Leader Appoints 1  Speaker of Assembly Appoints 1 ◦ Ex-officio  Director of Department of Health and Human Services  Director of Department of Business and Industry  Director of the Department of Administration

17 WEB SITE: govcha.state.nv.us/ address : Office of Consumer Health Assistance 555 E. Washington Ave., Suite 4800 Las Vegas, NV Fax: Office for Consumer Health Assistance MORE INFORMATION ON HEALTH CARE REFORM:


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