AHIP: 3 problems with proposed exchange rules

Health insurers are asking the federal government for more money to compensate for allowing plans that don't comply with the Affordable Care Act to continue until October 2017, reports Bloomberg BNA.

In addition to that request, America's Health Insurance Plans criticized some of the proposed rulings from the U.S. Department of Health and Human Services and Centers for Medicare and Medicaid Services on exchange and insurance market standards for 2015, according to a letter sent to CMS, obtained by FierceHealthPayer.

Below are concerns raised and AHIP's suggestions for solutions.

1. Activities that improve healthcare quality

Recent noncompliant delays means insurers will have to update many training activities, according to AHIP. Moreover, such continued delays will raise costs significantly. The current limit of earned premiums--0.3 percent--falls won't cover conversion readiness expenses, according to the health plan trade group.

What AHIP recommends: Raise the limit to 0.4 percent to better manage unanticipated costs.

2. Payment of premiums

The proposed rule would allow health exchanges to have multiple standard processes for calculating premiums to standardize a method of partial month premiums. AHIP notes that more than one method to calculate premiums may require differing system updates.

What AHIP recommends: Spell out whether the proration of premium applies to the first month's premium. If so, AHIP says this prorated payment should satisfy the "one month's premium" requirement.

3. Prescription drug benefits

Some enrollees experience difficulty in obtaining prescription drugs in a timely manner, so HHS is considering amending the standards to require processes for accessing drugs.

What AHIP recommends: Recognizing physicians often make non-formulary drugs available to their patients, AHIP asks that HHS better explain the access issues that are occurring before moving forward with this ruling.

For more:
- here's the BNA article