BNA Quotes Manatt Health Professionals on Health Reform Regulation

BNA Quotes Manatt Health Professionals on Health Reform Regulation

"Insurance Regulation Busy Time Ahead for Health Insurance, Other Regulations to Implement ACA"
BNA Health Daily Report

November 12, 2012 - BNA interviewed Manatt's Wendy Krasner, a partner in the firm's Healthcare Division, and Joel Ario, a managing director with Manatt Health Solutions, for insight into the regulations needed for ACA implementation.

BNA Health Daily Report writes that, with the prospect of having public health insurance exchange markets operating by 2014 under the Affordable Care Act, rules affecting insurers will be at the forefront of the whirl of regulations that will be issued in the weeks following President Obama's reelection. Industry observers noted that many questions still need to be answered, such as how the federally facilitated exchange will interact with state insurance departments and state Medicaid programs.

Ario told BNA that "market rules are the most pressing for states and insurers who need to know rules of the road for exchange and coverage expansion in 2014." Ario was the initial director of the Office of Insurance Exchanges in HHS's Center for Consumer Information and Insurance Oversight in 2010 and 2011.

States will have to license insurers before they can become qualified health plans (QHPs), and the question remains how the federal exchange, in determining QHPs, will interface with regulators.

The adequacy of QHP networks is a "sleeper issue with a huge number of open questions," said Krasner.

"In certifying QHPs for the exchanges, network adequacy is one of the core areas where the states must develop standards," Krasner said. Among the open questions are how the standards will accommodate the market shift by health plans toward tighter provider networks to rein in costs and how the standards will vary among the exchange market, the commercial market outside the exchanges, and the Medicaid managed care market.

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