1. Department of Insurance1 Update on LBTF and Review of Minimum Healthcare Protection Act Mike Batte Insure New Mexico! Council August 11, 2005

2. Department of Insurance2 Agenda for August 3, 2005 Task Force meeting Review other state efforts Review of Minimum Healthcare Protection Act Review possible proposals Insurer perspective Next steps

3. Department of Insurance3 Review of other state efforts Academy Health (SCI) issues brief Massachusetts Maryland Texas Washington

4. Department of Insurance4 Minimum Healthcare Protection Act Purpose Eligibility Managed care features Required benefits Required disclosures

5. Department of Insurance5 Purpose of MHPA “… to address limitations in access to healthcare by authorizing insurers, … to offer minimum healthcare services … at affordable rates to those … who may not desire or be able to afford more comprehensive healthcare services …”

6. Department of Insurance6 Eligibility Individuals, families & groups < 20 Without insurance for six-months (crowd out) Exceptions Group not in existence for 6 months Employer terminates coverage Change in dependent status Change in employment

7. Department of Insurance7 Managed care features Excludes not medically necessary Pre-authorization for hospital admission May include Network of providers 2 nd opinion for elective surgery Utilization review May limit coverage to $50,000

8. Department of Insurance8 Required benefits In-patient hospital, not < 26 days Pre-natal care Coverage for delivery Well baby and well child care Mammograms Cytologic screening Primary care, at least 7 office visits Childhood immunizations Smoking cessation

9. Department of Insurance9 Required disclosure Written disclosure to applicants Mandates not covered Managed care features Primary care features Signed written statement of applicant Certifies eligibility Acknowledges limited nature Acknowledges rejection of comprehensive coverage

10. Department of Insurance10 Review possible proposals Amend the “Minimum Healthcare Protection Act” Amend the “HMO Act” Create a “standard benefit plan” (the Texas approach)

11. Department of Insurance11 Insurer perspective Some mandates are costly Texas example 8% Anti-discrimination statutes are costly Unnecessary treatment related to Chiropractic medicine Unnecessary treatment related to DOM

12. Department of Insurance12 Next steps 2 meetings scheduled Drafts to amend MHPA (HMO?) Modify anti-discrimination