What’s Ahead for the Health Insurance Market State of Reform Conference January 8, 2014

Reminder of OIC’s Role Dual mission – Promote robust insurance market – Protect insurance consumers Regulatory authority 2 OIC AuthorityLimited or No Authority Fully-insured individual plansMedicaid, Medicare (some), UMP Fully-insured small group plansSelf-insured plans Fully-insured large group plansHealth care providers

Legislative Priorities NAIC Model Laws – Holding Company Act – Own Risk and Solvency Assessment – Credit for Reinsurance – Standard Valuation and Forfeiture IRO appeals for long-term care insurance 3

Rulemaking Priorities Network access rulemaking, part 2 – Context: Split first rulemaking into two parts – Goal: Clarify remaining standards, primarily the maintenance of networks over the plan year Prescription drug prior authorization – Context: Legislative directive to improve prior authorization process for prescription drugs – Goal: Adopt best practice recommendations of OneHealthPort working group 4

Rulemaking Priorities Patient privacy protection – Context: Confusion about consumers’ rights to privacy in billing and explanation of benefits – Goal: Clarify expectations for issuers, consumers, and providers Formulary transparency – Context: Consumers not aware of right to ask for formulary up front and costs difficult to estimate – Goal: Clarify consumer right to formulary information at point of sale 5

Other Priorities Mental health & substance use parity enforcement – Context: Supreme Ct. ruling bolsters parity rules – Goal: Eliminate blanket exclusions or age-based discrimination for mental health services Continue transition for group market – Context: Federal law require transition of some plans previously offered in large group market – Goal: Continue process begun in 2011 to transition these plans to the appropriate market 6

Other Priorities Database of health IRO appeals – Context: Decisions in health IRO appeals not readily available to consumers – Goal: Enhance consumer awareness of existing appeals process through database of decisions Preventive services standards – Context: Uneven implementation of ACA preventive services requirements – Goals: Partner with DOH and others to interpret and clarify federal preventive services standards 7

Other Priorities Health Policy Roundtable – Context: Next phases of health reform will benefit from collaboration with diverse stakeholders – Goal: Provide a regular forum to discuss OIC priorities and activities around health insurance policy 8

Questions? Emily Brice Senior Health Policy Advisor 9