Federal

Owing to multiple blizzards in Washington, Congress started its Head’s Day recess a full week early and conducted no official business last week. But, there was some legislative drama as Senate Majority Leader Harry Reid pulled the rug out from under Finance Committee Chairman Max Baucus by scrapping the Baucus jobs bill (lacking warning), which controlled many shape insurance items, and replacing it with a stripped down, narrow jobs bill. Whether the shape items Baucus originally inserted with Republican help will make it back to the table remains fuzzy. Among the shape items that have been dropped are: the COBRA eligibility extension (to May 31); the “doc fix” (to October, 2010) of Medicare reimbursement rates; and the favorable statutory direction to CMS to calculate the 2011 Medicare Advantage rates “as if” the doc fix were in place.

States

California shape insurance The Office of Patient Advocacy released a report card on the state’s HMOs last week. Aetna expected 3 out of 4 stars. The goal of the report card is to allow consumers to compare how well shape plans use personal medical records and help address conditions such as asthma, arthritis and diabetes.

COLORADO: Governor Bill Ritter held a press conference to announce what he calls “the next around of reforms that speak for common sense.” His legislative package includes bills to disqualify insurance companies from charging different rates due to a people gender, ensure that women have access to breast cancer screening, assure plain language is used in insurance forms, standardize insurance applications and explanations of repayment, and encourage greater use of online tools to place your name down people in broadcast programs. Apart from the Governor’s proposals, a bill that would establish a broadcast option was also introduced.

CONNECTICUT: In a small legislative session of only three months, the Insurance & Real Estate Committee wasted no time in putting forth an agenda that includes many concept drafts for repeat legislation from previous sessions. These include prohibiting shape insurance copayments for preventive care, limiting prescription drug copayments, prohibiting Social Security disability payment offsets, and exempting the Municipal Employees Shape Insurance Plans from the premium tax on small group premiums. In addition, the committee reintroduced legislation that includes nearly a dozen new shape benefit mandates. The Council for Affordable Shape Insurance, an independent reckon-tank, says that shape insurance mandates could increase premiums in Connecticut by more than 50 percent overall.

GEORGIA: A bill was proposed last week that would impose significant restrictions on insurers’ skill to rescind shape insurance policies. Aetna, through the Georgia Association of Shape Plans and AHIP, met with the lawmaker sponsoring the bill to express concerns with the bill.

INDIANA: The legislative session is at halftime, and the insurance agenda is now limited. Most insurance issue bills are officially dead, including a bill that would have prohibited shape plot provisions requiring a contracted provider to accept more than a certain number of patients; coverage for dialysis behavior regardless of whether the facility is contracted or not and lacking certain benefit restrictions; and a bill that would have allowed out-of-arrangement assignment of repayment. But, Aetna is expecting that a bill requiring insurer and HMO annual exposure of premium cost composition, including administrative expenditure, may be resurrected. A bill that restricts dental insurers and HMOs from establishing fee schedules for non-covered services passed the Senate, with our amendment to accommodate most of the key concerns expressed by opponents of the bill. As the bill stands, dental insurance plans may impose fee schedules for covered services, regardless of whether the plot really pays for the services rendered.

KANSAS: An amended version of S.B. 389 related to dental services passed the Senate Fiscal Institutions and Insurance Committee on February 11. The amended bill prohibits any contract between a shape insurer that offers a shape benefit plot and a dentist from containing a provision that requires the dentist to accept a fee schedule for services unless the service is a covered service. Committee amendments added to the definition of a “shape benefit plot” the subsequent: any subscription agreement issued by a non-profit dental service corporation; any policy of shape insurance bought by an individual; the state children’s shape insurance plot; and the state medical help program under Medicaid. We will continue to update you as this bill progresses and hope to make favorable changes as the bill moves through the House.

MASSACHUSETTS: Governor Deval Patrick filed a 40-page bill that proposes charitable the insurance commissioner the power to hold broadcast hearings on rate adjustments and essentially cap shape care price increases. Rate increases for individuals would be held to the rate of medical inflation; those sold to employers with 50 or fewer workers could not exceed one and a half times the level of medical inflation. The legislation would also impose a two-year moratorium on any new shape benefit mandates. Legislative leaders praised the intent of the governor’s plot but declined to promise support. Strong opposition is probable from medical provider groups. The Governor simultaneously announced emergency regulations to take immediate effect that will require shape insurers to submit proposed small business rate increases for assess by the state 30 days before they take effect. Several other proposed provisions include a requirement that insurers offer at least one coverage plot with a limited arrangement of shape care providers costing at least 10 percent less than shape plans with access to more physicians. The Massachusetts Association of Shape plans is lobbying in support of a bill introduced by Senate Insurance Chair Richard Moore that would make a cheaper shape insurance product for small employers by capping payments to providers at just 10 percent above Medicare rates. The Massachusetts Medical Society is hostile to that proposal.

MISSOURI: An autism coverage mandate bill was amended and “perfected” by the Senate and then sent to the Government Accountability and Fiscal Oversight Committee from which it must emerge before returning to the floor of the Senate. In addition to two mandate-related amendments, a third amendment to the bill allowing for limited place a stop to border sales of shape insurance also passed. In its current form, the bill contains a mandated offering of the coverage in the individual market. Coverage is limited to behavior ordered by a licensed physician or psychologist whose behavior plot the carrier is entitled to assess every six months. Coverage for applied behavior breakdown (ABA) is limited to $52,000 annually (down from the $72,000 as introduced) for persons under age 21. Meanwhile in the House, a bill containing significant language relating to the credentialing of autism service providers also passed. The bill also contains a mandate to offer coverage in the individual market and to groups of fewer than 25. Groups of 25 to 50 would be entitled to an immunity from the mandate if they could demonstrate an increase in premiums tied to the mandate. The bill limits annual coverage of ABA ($36,000 for children ages 3-9; $20,000 for children ages 9-21). Aetna will continue to monitor the status of these mandates, but it appears honestly clear at this point that something will pass on the issue of autism.

NEW JERSEY: Last week Governor Chris Christie declared a fiscal state of emergency calling a special session of the legislature to lay out his plot for dealing with state’s current $2.2 billion budget shortfall. His plot calls for significant cuts or eliminations across 375 state programs and withholding $500 million of state education aid. Of note on the program side is a $12.6 million reduction in Charity Care funding to hospitals, which pays for care to uninsured residents. In legislative proceedings, the Gathering Fiscal Institutions and Insurance Committee held a three-hour broadcast hearing on out-of-arrangement reimbursement. Much of the hearing focused on the markedly higher billing practices of ambulatory surgery centers and one non-par sickbay. Aetna presented testimony regarding its experience with the non-par sickbay, citing their disparate year-over-year increase in charges compared to other similarly situated hospitals. Chairman Schaer indicated the committee will work over the next several months to craft a solution.

NEW YORK: With Free Senator Hiram Monserrate officially expelled from the Senate, the Free majority (31-30) now faces an uphill battle getting the 32 votes needed to pass legislation. But, both the Senate and the Gathering went forwards with a broadcast hearing on the Executive Budget proposal for shape, including the section mandating the prior approval of rate adjustments. The Shape Plot Association testified on behalf of the industry. If enacted, Governor Paterson’s proposal for an 85 percent medical loss ratio and a prior approval hearing process for all rate adjustments would essentially amount to government control of shape insurance, discouragement the confidential shape insurance market in New York. Price controls would weaken shape plot solvency, hurt providers and virtually eliminate innovation and efficiency. At the same time, the proposal ignores the underlying cause of the increasing cost of shape insurance — the increase in the actual expenditure of shape care services.

OKLAHOMA: The following session of the 52nd Oklahoma Legislature convened in Oklahoma City on February 1. Legislators promptly turned to the state’s $1.3 billion budget deficit described by Governor Brad Henry (D) in his eighth and final state of the state address and FY 2011 executive budget. During his address, the Governor focused on his plans for resolving the $1.3 billion budget deficit through precise budget cuts. His only reference to shape insurance was to encourage the extension of Insure Oklahoma, a program developed by the state in partnership with small employers to grant affordable shape coverage. The legislature is scheduled to adjourn on May 28 but only after addressing a range of legislation including several bills of interest to Aetna.

SOUTH DAKOTA: A dental fee schedule bill (S.B. 108) unanimously passed the Senate Commerce Committee and is probable to be taken up by the full Senate early this week. The bill prohibits any contract between a shape insurer that offers a shape benefit plot and a dentist from containing a provision that requires the dentist to accept a fee schedule for services unless the service is a covered service. Aetna will continue to follow the bill’s progress as it progresses.

TENNESSEE: Several bills have been proposed that would make changes to the state’s external assess law. Aetna and other industry representatives will be meeting with the Tennessee Department of Commerce and Insurance regarding its proposed changes to the external assess law. The bill proposed by the TDCI most closely mirrors the model legislation proposed by the National Association of Insurance Commissioners.

UTAH: The Speaker of the House has introduced a shape reform bill addressing shape information equipment, individual and small group market reforms and transparency. The overarching theme of the reforms is micromanagement of rates and rating factors, and a broadening of the Insurance Commissioner’s authority. The transparency provisions apply plot designs and benefit descriptions submitted by carriers, and would require providers to make available, upon request, a price list for services on both an inpatient and outpatient foothold.