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Department Response to OLS Questions

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Department Response to OLS Questions Department of Banking and Insurance FY 2012-2013 Discussion Points 1a. The FY 2012 Appropriations Act included an $8.49 million increase in federal funding for the department. The increase in federal funding included three grants related to the “Patient Protection and Affordable Care Act,” Pub. L.111-148, and the “Health Care and Education Reconciliation Act of 2010,” Pub.L.111-152, collectively more commonly known as the “Affordable Care Act.” The first grant provided $982,000 from federal FY 2011 and $1 million from federal FY 2012 for the Consumer Assistance Program (CAP), which is a federally funded program that enhances and expands many of the services currently provided by the department’s Consumer Assistance Unit. The Consumer Assistance Unit, currently employing 9 investigators, two supervisors and a manager, is responsible for responding to consumer calls about health insurance issues of a technical or emergent nature. The staff also investigates inquiries and complaints involving all lines of insurance. According to the department’s response to the Office of Legislative Services (OLS) Discussion Points during the FY 2012 budget process, the enhancements funded with the federal monies include: increased staffing with two newly created positions devoted exclusively to consumer assistance; enhanced activities of existing staff; additional communications features; new consumer education programs and materials; additional training for staff; enhanced computer database systems and needed office supplies and materials. These enhancements are needed due to the changes to the health care system pursuant to the Affordable Care Act. For example, the State may now accept complaints from and advocate on behalf of persons covered by self funded health benefits plans, an area in which the State was precluded from interceding prior to enactment of the Affordable Care Act. Question: a. Please provide details on the activities funded by the Consumer Assistance Program grant, including the number of customer inquiries, by subject area. Response: The federal government awarded only one grant to the Department to fund a Consumer Assistance Program (CAP) under the Affordable Care Act. That grant was for the period from October 1, 2010 to September 30, 2011 and was for $928,000. The Department spent $265,019 of the grant funds primarily to fund staff salaries and fringe benefits for two new employees of the Consumer Protection Services area of the Department as well as to partially fund salaries of staff handling health insurance inquiries related to the Affordable Care Act. The two new employees conducted consumer outreach activities which included meetings with a variety of community organizations, local governments, provider groups, legislators, religious organizations, educational institutions and others to educate them about the health care options available in New Jersey. The employees developed resource lists for members of the public, trained current Department employees on various health related issues, and assisted in setting up the data reporting system required by CAP grant recipients. 1 Department of Banking and Insurance FY 2012-2013 Discussion Points (Cont’d) The Department handled 2,185 health related inquiries during the grant period and which are broken down by category as shown below. For the purposes of the chart, this is a description of the nature of the calls. Uninsured – A consumer with no health insurance. Insured in Transition – The consumer is insured at the time of initial contact with the program, but faces an imminent (within the next 12 months) loss of coverage. Insured Other Problems – An insured consumer who intends to keep current coverage but is having difficulty affording the premium or is experiencing adequacy problems. Information Only – Typically an insured consumer seeking general information, definitions, contact information, but not seeking assistance related to a specific health insurance problem. Other Assistance Referred – A consumer whose needs are outside of the scope of the program. Scenarios where this would apply include, but are not limited to: • a Medicaid recipient with questions about coverage; • a Medicare recipient with Part D having difficulty paying for prescriptions; or • a VA beneficiary seeking an expedited appointment with a doctor. Appeals – Consumers who have appeals due to denials of claims, termination of coverage when there was a claim represented and who seek information on options for appeal of carrier claim determinations. Nature of Call Number of Calls Uninsured 379 Insured in Transition 332 Insured Other Problems 558 Information Only 290 Other Assistance Referred 33 Appeals 593 Total 2,185 2 Department of Banking and Insurance FY 2012-2013 Discussion Points (Cont’d) b. Please provide the department’s plan to maintain CAP staff and activities in the absence of additional federal funding in FY 2013. Response: The Department has reassigned the employees that were hired as part of the CAP grant to the rate review grant as of October 2011 as that grant continues through the end of calendar year 2013. Remaining staff in Consumer Protection Services are responding to consumer and provider inquiries relating to health insurance, including external appeals. c. Please detail any new staff hired in FY 2012 or anticipated to be hired in FY 2013; and anticipated time of funding period. Response: The Department expects staffing in Consumer Protection Services to remain at current levels throughout FY 2013 and expects to hire only to replace departing employees. 1b. The second grant for $1 million from federal FY 2011 and for $3 million from federal FYs 2012 through 2014 will enhance the department’s ability to review insurance companies’ rate proposals. Pursuant to the Affordable Care Act, the federal Department of Health and Human Services must work with state insurance departments to review unreasonable rate increases for health insurance plans. (Please see the OLS background paper, beginning on page X of this analysis book, “Health Insurance Rate Review; Federal Health Care Reform Law Requirements” for more information.) These grants are being used to hire a consultant group to study the actuarial information that should be included in the rate filing and develop an automated process for receiving and analyzing the numerical information in rate filings. The funding is also being used, in cooperation with other states’ funding, to assist the National Association of Insurance Commissioners (NAIC) to modify the State Electronic Rate and Form Filing (SERFF) system to allow direct capture of the information on rate increases. The State will also hold annual rate forums and prepare a report on the effectiveness of its rate review process, training and outreach efforts to stakeholders. Additionally, New Jersey has been awarded “workload” funding of $546,261 and a “performance” award of $600,000. Question: a. Please update the Legislature on the work of the Hays consultant group hired to develop an automated process for receiving and analyzing the numerical information in rate filings and the progress of the NAIC in modifying the SERFF system. Response: The Hay Group was engaged and began work in early 2011. The following projects have been completed or are nearly completed: 1. met with major New Jersey health carriers on March 15-16, 2011 to elicit their concerns on the rate review process. 2. met with stakeholder groups (such as consumers, brokers, medical care providers, legislative staff) on June 1-2, 2011 to learn about concerns on the rate review process. These meetings were 3 Department of Banking and Insurance FY 2012-2013 Discussion Points (Cont’d) moderated by the Rutgers Center for State Health Policy (RCSHP). The Department previously contracted with RCSHP to conduct regional meetings with stakeholders. 3. developed rate filing “templates” (Excel work books for standardized filing of rate data) and an instruction manual. These templates went into use January 2012. 4. developed a data base for maintaining the uniform information submitted in the templates. This data base is currently undergoing testing. There are also several pending projects: 1. completion of testing and finalization of the data base; 2. train Department staff in use of the data base; 3. drafting a report on methods and considerations for filing rates; 4. uniform formats for summarizing benefits in rate filings and 5. special reports on rate errors, loss ratios, pre-reform rate filings, and large group rate filings. The SERFF modifications have been completed. Cycle I modifications completed in late 2010 and early 2011 provided for summary rate data to be directly entered into the SERFF filing and automatically reported to HHS on a quarterly basis. This relieves states with rate review grants from the burden of collecting and reporting rate data. Cycle II modifications completed in late 2011 allow carriers to include in their filing the “justifications” required to be posted by HHS. b. Please provide an update on any changes the department is anticipating to the process of rate review currently used by the department for health insurance rates. Response: The Department believes that it is too early in the process to answer this question. The Department anticipates that our new process will be faster and that the questions asked will be more specific and informed by the available data. c. Please detail the specific activities to be performed with the “workload” and “performance” funding. Response: The
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