HHS awards State of Vermont $3.8 million for insurer rate review

first_imgBISHCA, 9.20.2011 The Vermont Department of Banking, Insurance, Securities & Health Care Administration (BISHCA) has been awarded a three-year, $3.8 million grant from the federal Department of Health & Human Services (HHS). The grant is part of the ‘Affordable Care Act ‘ Rate Review Grant Program’ and was awarded through HHS’s Office of Consumer Information & Insurance Oversight. ‘We are extremely pleased to learn that we’ve been awarded this grant,’ said Commissioner Steve Kimbell. ‘Linking knowledgeable Vermont consumers to the health insurance rate setting process is an important tool in controlling health care costs. This grant is yet another example of the benefit to Vermont of President Obama’s health care reform legislation.’ BISHCA had applied for the funds to enhance the rate review process, ensuring greater transparency and access to affordable health insurance for Vermont residents. BISHCA will use these funds to develop filing standards for Third Party Administrators, post rate filings for public comment to its website and build the data and analytical structure to support a more comprehensive rate review process.US Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced Affordable Care Act grant awards of $3,804,045 to Vermont that will help fight unreasonable premium increases and protect consumers. HHS also released a new report entitled Rate Review Works detailing how previous rate review grants are fighting premium hikes and helping make the health insurance marketplace more transparent.As of September 1, 2011, the Affordable Care Act requires health insurers seeking to increase their rates by 10 percent or more in the individual and small group market to submit their request to experts to determine whether the rates are unreasonable. The Affordable Care Act also requires insurance companies to publicly justify unreasonable premium rate increases. These provisions will bring greater transparency, accountability, and, in many cases, lower costs for families and small business owners who struggle to afford coverage.‘We’re committed to fighting unreasonable premium increases and we know rate review works,’ said Secretary Sebelius. ‘States continue to have the primary responsibility for reviewing insurance rates and these grants give them more resources to hold insurance companies accountable.’The Affordable Care Act provides States with $250 million in Health Insurance Rate Review Grants, $48 million of which has previously been awarded to 42 States, the District of Columbia and five territories.As outlined in the new report, these grants and other State rate review efforts are already making a difference in Vermont. The state has used funds to further standardize its filing requirements. In an effort to expand their analysis of rates, the Insurance Division is conducting an extensive review of claims data. The State’s consumer website was also updated to include consumer-friendly rate summaries as well as a consumer comment capability.The grants awarded today help to create a more level playing field by improving how States review proposed health insurance rates and holding insurance companies accountable for disclosing information about unjustified rate increases.Vermont is proposing to use Cycle II grant funds in the following ways:Expand scope of rate review: Vermont will continue to review minor health insurance products of insurance and will continue to enhance the review rates in the large group market.Improve rate filing requirements: Vermont plans to continue the development of filing standards for individual and small group and will continue collecting relevant data and information from Third Party Administrators (TPAs).Improve transparency and consumer interfaces: Vermont will maintain and enhance its new rate review website, post filings within 5 days of receipt to encourage consumer comment, and use market research to support the State’s review of rate increases.Hire new staff: Vermont will create 2 new positions with Cycle II grant funding; these positions are in addition to the 1 position created with Cycle I resources.Improve IT: Vermont plans to build the data and analytical structure to support a more comprehensive rate review process with enhanced transparency, including the integration of hospital budget reviews in the rate review process.A summary of how each State will use the new resources can be found in the report released today.‘The proposals from the States overwhelmingly demonstrate the need, and desire, for new resources and tools to hold insurance companies accountable,’ said Steve Larsen, Director of the Center for Consumer Information and Insurance Oversight. ‘Thanks to the Affordable Care Act, States will have more of the tools they need to crack down on insurance companies that want to pass unreasonable premium hikes on to hard working families.’Information about significant State achievements with previous rate review grants can also be found in the report.Rate review builds on other provisions in the Affordable Care Act to help make health insurance more affordable for individuals, families, and businesses. Other steps the law takes to help make insurance more affordable include:Insurers are generally required to meet a medical loss ratio standard to spend at least 80 percent of premium dollars on health care and quality-improvement activities as opposed to overhead, advertising, and executive bonuses. Insurers that fail to meet that standard must either reduce premiums or pay rebates to consumers and employers;Small businesses are eligible for Federal tax credits of up to 35 percent of the cost of coverage for their workers. That amount rises to 50 percent by 2014; andIn 2014, the Affordable Insurance Exchanges will use competition and transparency, including information on excessive or unjustified premium increases, to help make insurance more affordable.The Affordable Care Act includes a variety of provisions designed to promote accountability, affordability, quality, and accessibility in the health care system for all Americans, and to make the health insurance market more consumer-friendly and transparent. Some of the provisions are already in effect, including prohibitions on pre-existing condition exclusions for children; prohibitions on lifetime dollar limits in all health plans; extended access to insurance for many young adults; and an unprecedented level of transparency about health insurance through www.HealthCare.gov(link is external).For the full Rate Review Works report, please visit: http://www.healthcare.gov/law/resources/reports/rate-review09202011a.pdf(link is external)For a fact sheet on the awards announced today, please visit: http://www.healthcare.gov/news/factsheets/2011/09/rate-review09202011a.html(link is external)last_img

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