Health Care

Regulatory Letters

2011 Regulatory Letters

Eligibility and Enrollment Standards (October 2011)
Under the ACA, millions of individuals and families will finally be able to access affordable health coverage through insurance affordability programs, including premium tax credits, cost-sharing reductions, Medicaid, CHIP, and State-established Basic Health Programs. The National Partnership commended the Administration’s efforts to simplify and coordinate the eligibility and enrollment standards and processes across these programs, and offered recommendations for changes to proposed rules to ensure that low- and moderate-income women and families have seamless access to affordable coverage.

Establishment of Exchanges and Qualified Health Plans (October 2011)
The Affordable Care Act calls on states to create new one-stop insurance markets, known as health insurance Exchanges, where consumers can search through insurance coverage options and determine whether they are eligible for insurance affordability programs like subsidies. These Exchanges have the potential to offer women new opportunities to better assess coverage options in terms of costs, quality, network adequacy, comprehensiveness of benefits, reliability and responsiveness to enrollee needs. The National Partnership recognized that these rules set the Exchanges on the right path, but could be improved by greater consumer input in governance, guaranteed access to women’s health services in plans offered by the Exchanges, robust tools for consumer assistance (including clear explanations on quality and value for consumers), and the use of standardized performance measures for improvement.

Summary of benefits and coverage and the uniform glossary (October 2011)
The Affordable Care Act requires insurance companies to provide a summary of benefits and coverage (SBC) and a uniform glossary to help consumers make informed decisions about their health insurance coverage. In its detailed comment letter, the National Partnership recommended that the Department of Health and Human Services explore how insurers and employers could minimize the costs associated with compliance, ensure that consumers receive the SBC in a timely fashion, and make the summary available in a paper form unless an electronic copy is requested. We also recommended that the Department adopt more robust plain writing and language access standards amend the glossary to better meet consumer information needs.

Women’s Preventive Services (September 2011)
The Department of Health and Human Services announced that it would adopt the Institute of Medicine’s recommendations to include eight categories of preventive services, including all FDA-approved contraceptive methods, as part of the Women’s Health Amendment (WHA) in the Affordable Care Act (ACA). This is huge victory for women, yet the interim final rule had one caveat. The National Partnership recommended that HHS remove the refusal clause provision that allows certain religious employers to refuse to provide these comprehensive services.

Requirements for Multi-State Plans (September 2011)
The National Partnership and other consumer, patient and labor organizations recommended that multi-state plans, overseen by the Office of Personnel Management, comply with all federal and state regulations, including all requirements to serve as a Qualified Health Plan in states’ exchanges. This would prevent unfair advantages in the market place and differences in coverage that would undermine key consumer protections. >Demographic Data Collection Standards for Population Health Surveys (August 2011)
Members of The Leadership Conference on Civil and Human Rights Health Care Task Force (which the National Partnership co-chairs) applauded the Department of HHS for releasing proposed standards for collection and reporting of data on race, ethnicity, primary language, sex, and disability status and their plan to integrate questions on sexual orientation and gender identity into national data collection efforts by 2013. The groups urged the Department to continue to adopt more granular standards and apply them broadly across the health care system.

CMS Rule on Medicare Shared Savings Program: Accountable Care Organizations (ACOs) (June 2011)
Accountable Care Organizations (ACOs) are a potentially innovative health care delivery model that could provide an opportunity to improve the quality of our healthcare system by delivering coordinated, patient- and family-centered care. Commenting on the proposed rule for establishing ACOs in Medicare, members of The Leadership Conference on Civil and Human Rights Health Care Task Force (which the National Partnership co-chairs) recommended that there be even greater consumer stakeholder participation. We also urged CMS to strengthen the rule by considering the unique needs of underserved and vulnerable populations who face disparities in health.

Young Adult Dependent Coverage, Mini-Med Plans (May 2011)
One of the earliest successes of the Affordable Care Act is the large number of young adults who now have health insurance coverage from their parent’s health plan. Despite this success, the regulations were unclear as to whether an employer offering very low-quality benefits or "mini-meds" to young adults could disqualify their coverage on a parent’s plan. The National Partnership partnered with other consumer groups to recommend to HHS that mini-meds should not qualify as eligible employer-sponsored coverage since these plans only provides minimal coverage, rather than the comprehensive care and services that the Affordable Care Act intended.

Recommendations for Catastrophic Health Plans (April 2011)
The Affordable Care Act allows for catastrophic health plans to be sold to individuals under age 30 and to those who are unable to afford comprehensive coverage. These plans are prohibited by law from providing any benefits aside from preventive services and three primary care visits before the enrollee pays almost $6,000 in cost-sharing. The National Partnership and other consumer organizations sent recommendations to Secretary Sebelius regarding the basic regulatory protections that are necessary to ensure that these plans are consistent with congressional intent, which is focused on providing consumers with access to basic primary and preventive care, and ensuring that consumer are well-aware of the greater cost-sharing required by these plans.

Protecting the Medical Loss Ratio (March 2011)
The Affordable Care Act requires insurers to spend at least 80-85% of premium dollars on providing beneficiaries with health care and improving the quality of their care, and not on administrative costs and profits. The National Partnership and a number of consumer and patient advocacy organizations wrote to Secretary Sebelius opposing efforts to undermine this important consumer protection.

Conflict of Interest Protections in Exchange Governing Bodies (March 2011)
One of the most important issues that states face as they draft health insurance exchange legislation is who will govern the exchange. Although multiple parties have an interest in the competitive insurance market that exchanges will create, the primary goal of the exchanges is to serve health insurance consumers. The governing boards of exchanges must ultimately represent health insurance consumers and employers. The National Partnership joined forces with a number of consumer organizations in making recommendations on exchange governance.

Comments on the Rate Increase Disclosure and Review Notice of Proposed Rulemaking
(February 2011)
The Affordable Care Act calls on states to review unreasonable health insurance rate increases to protect consumers and small businesses from unfair, discriminatory hikes in their premium costs.  The National Partnership wrote to the Department of Health and Human Services to ensure that this important protection apply evenly across all small businesses up to 100 employees and not defer to state definitions which may restrict its application to only groups with fewer than 25 or 50 employees.

Recommendations for Regulations on Employer Wellness Programs (February 2011)
In December, 2010, the Departments of Labor, Treasury and Health and Human Services announced their intention to propose regulations to increase how much employers can reward or penalize employees who participate in outcomes-based wellness programs as part of employer-sponsored health insurance. The current 20 percent limit on cost variation would be increased to 30 percent of the total cost of employee coverage - a substantial amount of money.  The National Partnership joined other patient and consumer advocacy organizations to urge the Departments to issue regulations that would ensure that employer wellness programs do not become a subterfuge for discrimination based on an employee’s health status.

Comments on the Medical Loss Ratio Interim Final Rule (January 2011)
The Affordable Care Act requires insurers to spend at least 80-85% of premium dollars on providing beneficiaries with health care and improving the quality of their care, and not on administrative costs and profits. If an insurer doesn’t meet this requirement, it will have to provide its beneficiaries with a rebate of the portion of premium dollars that exceeded this limit.  The National Partnership and a number of consumer and patient advocacy organizations offered comments on the interim final rule implementing this requirement.

Comments on Priorities for Pediatric Quality Measures (January 2011)
In conjunction with Childbirth Connection, the National Partnership submitted comments on priorities for the Children’s Health Insurance Program (CHIP) pediatric quality measures program.  Through CHIP, the country has the opportunity to focus national resources and attention on performance measurement in the realm of child health care, including the promotion of healthy birth.

Comments on the Draft National Prevention Strategy (January 2011)
The Affordable Care Act calls for the creation of a comprehensive and coordinated National Prevention Strategy.  The National Partnership believes that the National Prevention Strategy can play a vital role in moving  our country toward a health model based on wellness, but urge the federal government to recognize the importance of sexual health as an essential, integral component of overall health and incorporate reproductive and sexual health into the National Prevention Strategy.

Comments on the Translation Threshold for Medicare Advantage and Medicare Prescription Drug Plans (January 2011)
The Centers for Medicare and Medicaid Services (CMS) issued proposed regulations that would require private Medicare plans (Part C and D plans) to translate written materials only into languages spoken by 10 percent of the population in the plan’s service area. Under this standard most of the approximately three million limited English proficient (LEP) Medicare enrollees would not get translated materials from their plans. Even Spanish-speaking enrollees would be left out in many states. The National Partnership submitted comments encouraging CMS to lower this threshold to ensure LEP Medicare beneficiaries will have access to the same high quality and safe care as everyone else.

Recommendations for Health Risk Assessment Guidance (January 2011)
Health Risk Assessments (HRAs) can play an important role in supporting effective primary care. With appropriate protections in place, HRAs can be useful tools that engage patients and their caregivers in their health care. Further, HRAs can foster conversations between patients/caregivers and practitioners about the steps they can and want to take to improve or maintain their health and quality of life, as well as the role the practitioner will play in that process.  The National Partnership offered recommendations to the Centers for Disease Control and Prevention for how the potential benefits of HRAs can be maximized while ensuring patients are not unfairly penalized or discriminated against.

2010 Regulatory Letters

Comments on the Draft Framework for the National Prevention and Health Promotion Strategy (December 3, 2010)
The National Prevention, Health Promotion, and Public Health Council, chaired by the Surgeon General, released a draft framework for the National Prevention and Health Promotion Strategy. The National Prevention Strategy will guide the Council in developing more specific recommendations, action steps, and strategies to improve the health and quality of life for all Americans. The National Partnership offered comments on how the framework could be improved to ensure the National Prevention Strategy can meet the unique needs of women and families.

Comments Related to Health Insurance Exchanges (October 2010)
The Affordable Care Act calls on states to establish new consumer-friendly health insurance marketplaces, referred to as exchanges. If implemented effectively, exchanges can be a trusted, independent resource where women and families can assess plans based on cost, quality, the provider network, and comprehensiveness of benefits. Exchanges also have the potential to enforce and expand consumer protections, and drive delivery and payment system reform and quality improvement.

In response to a request for information from the Department of Health and Human Services, we offered our comments on what must be considered and the steps that must be taken to ensure that exchanges live up to this potential.

Comments Regarding Privacy Concerns Related to New requirements for Internal Claims and Appeals and External Review Processes (September 2010)
The Affordable Care Act broadens and strengthens a consumer’s right to appeal decisions made by her health plan, for example refusing to pay claims for a treatment or service. Although we strongly support efforts to ensure that patients have access to a full and fair appeals process, we are concerned that the new rules raise significant privacy concerns that may impinge upon patients’ rights to confidentiality of their medical information. The National Partnership and the Center for Democracy & Technology shared our mutual concerns with the Administration and offered a balanced solution.

Comments on the Interim Final Rule Related to Coverage of Preventive Services (September 2010)
Beginning September 23, 2010, all new health plans must cover certain preventive services, such as mammograms and colonoscopies, without charging a deductible, co-pay or coinsurance. We joined forces with other consumer advocacy and labor organizations to offer recommendations to the Administration on how to strengthen and clarify the rules implementing this important new benefit.

Comments on the Patients Bill of Rights Regulations (August 2010)
The Affordable Care Act includes a number of important new consumer protections, commonly referred to as “The Patients Bill of Rights.” These protections will, beginning this year, provide children with pre-existing conditions access to coverage, and in 2014 provide all people with access to coverage regardless of their health status; ensure that coverage continues to protect people who face serious and costly illnesses by restricting and eventually eliminating annual and lifetime dollar limits; prevent abusive retroactive cancellations of coverage; help people choose providers that will ensure continuous and coordinated care; and improve coverage for people who face an emergency and must obtain treatment out-of-network. The National Partnership partnered with other consumer advocacy and labor organizations in thanking the Administration for their strong regulations implementing these provisions, and offering comments on how additional protections can be built into the rules.

Comments on Interim Final Rule on Grandfathered Status (August 2010)
Under the Affordable Care Act, plans existing on or before March 23, 2010 may qualify for “grandfathered status” and not be subject to many of the new insurance market reforms, like coverage of preventive health benefits without cost sharing and strengthened internal and external appeals processes. The Administration released an Interim Final Rule defining what changes a plan can and cannot make if it wants to retain its grandfathered status. In conjunction with other consumer advocacy and labor groups, we offered recommendations to strengthen the grandfathering regulations and ensure existing plans do not find loopholes to curtail individuals’ access to health care while maintaining grandfathered status.

Recommendations for Calculating Health Insurers’ Medical Loss Ratio (August 2010)
Under the Affordable Care Act, health plans are required to report on the percentage of premium dollars spent on clinical services and activities that improve health care quality (commonly referred to as the “Medical Loss Ratio”). Plans that do not meet a particular threshold (85% for plans in the large group market and 80% for plans in the individual and small group markets) must provide rebates to enrollees. The National Association of Insurance Commissioners is tasked with coming up with initial recommendations for how to calculate this percentage and must determine what counts as quality improvement activities. We teamed up with AARP to offer our recommendations on the proposal.

Comments on Requirements for the Health Insurance Web Portal (Healthcare.gov) (June 2010)
The Affordable Care Act calls on the Department of Health and Human Services (HHS) to develop an insurance Web portal through which individuals and small businesses can identify affordable health insurance coverage options in their State. In response to HHS’ initial plans for creating the Web portal, Healthcare.gov, the National Partnership offered recommendations for how the plans could be strengthened to ensure that women and families including those with limited English proficiency, disabilities, and low health literacy have access to meaningful information that is both comprehensive and understandable.

Recommendations for Implementing Immediate Insurance Market Reforms (April 2010)
A number of key changes to the insurance market under the Affordable Care Act go into effect in 2010. Before any regulations were released, we partnered with other consumer advocacy organizations to write to the Administration about these “immediate” insurance market reforms to ensure that implementation was guided first and foremost by the needs of patients and consumers.