HEALTH INSURANCE AND MANAGED CARE (B) COMMITTEE Sunday, August 16, 2015 3:30 5:00 p.m. Hyatt Regency Chicago Regency CD Gold Level West Tower

Date: 8/12/15 2015 Summer National Meeting Chicago, Illinois HEALTH INSURANCE AND MANAGED CARE (B) COMMITTEE Sunday, August 16, 2015 3:30 5:00 p.m. Hyatt Regency Chicago Regency CD Gold Level West Tower ROLL CALL AGENDA Roger A. Sevigny, Chair Mike Kreidler, Vice Chair Darren Ellingson Marguerite Salazar Mike Rothman Anthony Albanese Laura N. Cali Teresa D. Miller Ángela Weyne Todd E. Kiser Jacqueline K. Cunningham Ted Nickel Tom Glause New Hampshire Washington Arizona Colorado Minnesota New York Oregon Pennsylvania Puerto Rico Utah Virginia Wisconsin Wyoming 1. Hear Updates on the Center on Health Insurance Reforms (CHIR) Work Related to the Federal Affordable Care Act (ACA) JoAnn Volk (CHIR, Georgetown Health Policy Institute) 2. Receive a Federal Legislative Update Sean Dugan (NAIC) 3. Hear Update from the Federal Center for Consumer Information and Insurance Oversight (CCIIO) on Federal Affordable Care Act (ACA) Implementation Activities Amanda Schnitzer (CCIIO) 4. Consider Adoption of its June 11 Minutes Commissioner Roger A. Sevigny (NH) 5. Consider Reviving the Medical Loss Ratio Quality Improvement Activities (B) Subgroup Commissioner Roger A. Sevigny (NH) 6. Consider Adoption of its Subgroup, Working Group and Task Force Reports Consumer Information (B) Subgroup Angela Nelson (MO) Model Law Review Initiative (B) Subgroup Tanji Northrup (UT) Health Care Reform Regulatory Alternatives (B) Working Group Commissioner Ted Nickel and Dan Schwartzer (WI) Health Actuarial (B) Task Force Commissioner Jim L. Ridling (AL) and Steve Ostlund (AL) Regulatory Framework (B) Task Force Commissioner Ted Nickel (WI) and J.P. Wieske (WI) Senior Issues (B) Task Force Commissioner Kevin M. McCarty (FL) 7. Discuss Potential Committee Issues for 2016 Charges Commissioner Roger A. Sevigny (NH) 8. Discuss Any Other Matters Brought Before the Committee Commissioner Roger A. Sevigny (NH) 9. Adjournment W:\National Meetings\2015\Summer\Agenda\B Cmte Agenda 8-16-15.docx 2015 National Association of Insurance Commissioners

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Agenda Item #1 Hear Updates on the Center for Health Insurance Reforms (CHIR) Work Related to the Federal Affordable Care Act (ACA) JoAnn Volk (CHIR, Georgetown Health Policy Institute)

How States Are Protecting Consumers from Unexpected Charges JoAnn Volk National Association of Insurance Commissioners Health Insurance and Managed Care (B) Committee August 16, 2015

State Actions on Balance Billing Scenarios addressed: emergency settings, surprise billing in a network hospital, consultations or services out-of-network About ¼ of all states address at least one of the scenarios that typically result in unexpected charges Study states: CA, CO, FL, MD, NM, NY and TX Represent a range of state approaches NM as example of state that doesn t have a law; market conditions mean balance billing infrequent

Summary of State Approaches Hold harmless or prohibition in emergency situations Hold harmless or prohibition in surprise bills CA* CO FL* MD* NM NY TX* Yes Yes Yes Yes No Yes Yes No Yes Yes Yes No Yes Yes Hold harmless or prohibition in other situations Mediation or dispute resolution process Disclosure beyond standard notice No Yes No Yes No Yes Yes Yes No Yes No No Yes Yes No No No Yes No Yes Yes

Cross-Cutting Issues Emergency vs. surprise billing situations Greater support for emergency situations but growing attention to surprise billing Narrowing networks could increase likelihood, drive interest in addressing surprise billing Degree of consumer protection varies Some approaches more effective at keeping consumer out of dispute between plan and provider Some gaps based on segments of market not covered by protections

Balancing provider and insurer interests Rate setting: MD sets specific requirements for payment levels to be paid by insurers; NY sets guidelines for reasonable payment Dispute resolution: NY uses independent dispute resolution, at request of provider or plan; FL and TX have IDR processes that are rarely used Cross-Cutting Issues

Disclosure and Transparency: Many states have expanded disclosure requirements, but stakeholders question whether such requirements are adequate without other measures. Used in lieu of more direct protections (PPOs in TX), or as complement to other measures (NY) Impact on market: some stakeholders expressed concerns that protections may interfere with network negotiations Cross-cutting Issues

by Jack Hoadley, Sandy Ahn and Kevin Lucia Available at: http://www.rwjf.org/content/dam/farm/rep orts/issue_briefs/2015/rwjf420966 Balance Billing: How Are States Protecting Consumers from Unexpected Charges

Agenda Item #2 Receive Federal Legislative Update NO MATERIALS

Agenda Item #3 Hear Update from the Federal Center for Consumer Information and Insurance Oversight (CCIIO) on Federal Affordable Care Act (ACA) Implementation Activities Amanda Schnitzer (CCIIO): -- NO MATERIALS

Agenda Item #4 Consider Adoption of its June 11 Minutes

Attachment One Health Insurance and Managed Care (B) Committee 8/--/15 Draft: 6/19/15 Health Insurance and Managed Care (B) Committee Conference Call June 11, 2015 The Health Insurance and Managed Care (B) Committee met via conference call June 11, 2015. The following Committee members participated: Roger A. Sevigny, Chair (NH); Mike Kreidler, Vice Chair (WA); Germaine L. Marks (AZ); Marguerite Salazar represented by Peg Brown (CO); Mike Rothman represented by Tim Vande Hey (MN); Scott J. Kipper (NV); Benjamin M. Lawsky represented by Jeffrey Pohl (NY); Laura N. Cali (OR); Teresa D. Miller represented by Peter Camacci (PA); Ángela Weyne (PR); Todd E. Kiser represented by Tanji Northrup (UT); Jacqueline K. Cunningham represented by Julia Blauvelt (VA); and Ted Nickel and J.P. Wieske (WI). Also participating were: Steve Ostlund (AL); and Angela Nelson (MO). 1. Adopted its Spring National Meeting Minutes Commissioner Cali made a motion, seconded by Director Marks, to adopt the Committee s March 29, minutes (see NAIC Proceedings Spring 2015, Health Insurance and Managed Care (B) Committee). The motion passed unanimously. 2. Adopted the Stop Loss Insurance, Self-Funding and the ACA White Paper Mr. Wieske said the Regulatory Framework (B) Task Force unanimously adopted the Stop Loss Insurance, Self-Funding and the ACA white paper via conference call June 4 (see NAIC Proceedings Summer 2015, Regulatory Framework (B) Task Force Minutes, Attachment One-A). He said the white paper is intended to be a primer for state insurance regulators to use to help them understand how stop loss insurance works with self-funding and what they should be looking for as related to such insurance in form filings. Mr. Wieske said he believes the white paper provides a balanced point of view on what issues state insurance regulators may want to consider regarding stop loss insurance and if those issues raise policy concerns for them, what options may be available to address them. Commissioner Kreidler made a motion, seconded by Mr. Vande Hey, to adopt the Stop Loss, Self-Funding and the ACA white paper. The motion passed unanimously. 3. Approved Recommendation to Fund Consumer Testing of SBC Changes Ms. Nelson said the Committee has before it today a memorandum from the Consumer Information (B) Subgroup recommending that the Committee approve a recommendation that the NAIC fund consumer testing of the Summary of Benefits and Coverage (SBC) template and uniform glossary. She said that, under the federal Affordable Care Act (ACA), the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Labor (collectively, the Departments ) were required to consult with the NAIC in developing the initial SBC template and uniform glossary. The NAIC, through the work of the Consumer Information (B) Subgroup, submitted its recommendations for the SBC template and uniform glossary to the Departments in December 2010. The Departments adopted the recommendations as part of their final rule, which remains in effect today. Ms. Nelson said that, in November 2014, the Departments issued a formal Notice of Proposed Rulemaking (NPRM), which included a revised SBC template and uniform glossary. She said that in issuing the NPRM, the NAIC was not consulted regarding any of the proposed revisions. As a result, the Consumer Information (B) Subgroup drafted a comment letter to the Departments, in response to the NPRM, outlining its previous work and recommending that the NAIC be asked once again to review the SBC template and uniform glossary for potential revisions. The letter was adopted by the Government Relations (EX) Leadership Council and submitted to the Departments in March. Ms. Nelson said that in response to the letter, the Departments asked the NAIC and the Consumer Information (B) Subgroup to review the current SBC template and uniform glossary and to make recommendations for revising them. She explained that during the development of the current SBC template, the Consumer Information (B) Subgroup relied upon industry and consumer stakeholder to use their resources to conduct consumer testing of the draft SBC template. In contemplating revisions to the current SBC template, the Consumer Information (B) Subgroup members, federal regulators and other interested parties have agreed that consumer testing is essential to ensure any revisions meet consumer needs. 2015 National Association of Insurance Commissioners 1

2015 National Association of Insurance Commissioners 2 Attachment One Health Insurance and Managed Care (B) Committee 8/--/15 Ms. Nelson said the Consumer Information (B) Subgroup discussed whether it should draft its proposed revisions to the SBC template and allow the Departments to conduct consumer testing and incorporate that feedback in the final rule or if the NAIC should to conduct the consumer testing prior to making its final recommendation to the Departments. She said the Consumer Information (B) Subgroup unanimously adopted a recommendation that the NAIC should fund and conduct the consumer testing of the revised SBC. Ms. Nelson said the Subgroup reached this recommendation for a number of reasons, but particularly because the Departments have been unable to guarantee that the NAIC or the public will be given access to the final consumer testing results or that any additional comments will be considered. If the NAIC funds and conducts the consumer testing, then the Consumer Information (B) Subgroup would have access to the testing process and its results and be able to incorporate the results into its final recommendations for the revised SBC template. In addition, if the NAIC funds and conducts the consumer testing, it would ensure that the entire process is open and transparent to all stakeholders. Ms. Nelson noted that if the request to fund and conduct consumer testing is approved, the consumer testing will need to be completed no later than Aug. 1, with the final results delivered to the Consumer Information (B) Subgroup no later than mid-august. She said this timetable should enable the Consumer Information (B) Subgroup to deliver its final recommendations for a revised SBC template and uniform glossary to the Departments by early September. Mr. Vande Hey made a motion, seconded by Commissioner Kreidler, to adopt the recommendation that the NAIC fund and conduct consumer testing of the SBC template and uniform glossary. The motion passed unanimously. Commissioner Sevigny noted that the Executive (EX) Committee will consider this Committee s recommendation via a conference call to be held June 12. 4. Received Reports from its Subgroups, Working Group and Task Forces a. Consumer Information (B) Subgroup Ms. Nelson said the Consumer Information (B) Subgroup has been meeting via conference call twice a week since May. She noted that the Subgroup was initially meeting for one hour, but recently increased the length of its calls to 90 minutes in order to expedite its work to revise the SBC template and uniform glossary. Ms. Nelson said the Subgroup s first few conference calls were devoted to receiving information from individuals, including certified application counselors, navigators and insurance producers who have firsthand experience using the SBC template and uniform glossary. She said that in the Subgroup s recent conference calls, it has begun the process of discussing potential revisions to the SBC. Ms. Nelson said the Subgroup is making slow but steady progress, and she believes that, in the end, the Subgroup will develop a new and improved SBC template, not simply a revised one. b. Model Law Review Initiative (B) Subgroup Ms. Northrup said the Model Law Review Initiative (B) Subgroup met via conference call April 23. She said that during this meeting, the Subgroup adopted recommendations to retain as NAIC models the five NAIC models it was charged to review: the Discount Medical Plan Organization Model Act (#98); the Health Policy Rate and Form Filing Model (Act) (Regulation) (#165); the Prevention of Illegal Multiple Employer Welfare Arrangements (MEWAs) and Other Illegal Health Insurers Model Regulation (#220); the Long-Term Care Insurance Model Act (#640); and the Long-Term Care Insurance Model Regulation (#641). Ms. Northrup said the Subgroup will report its recommendations to the Committee at the Summer National Meeting. c. Health Care Reform Regulatory Alternatives (B) Working Group Commissioner Nickel said the Health Care Reform Regulatory Alternatives (B) Working Group has not met since the Spring National Meeting. He said the Working Group plans to meet at the Summer National Meeting, but, at this point in time, it has not determined the focus of the discussion at the meeting because that is dependent on the U.S. Supreme Court s decision in King v. Burwell, which is expected to be issued later this month. d. Health Actuarial (B) Task Force Mr. Ostlund said the Health Actuarial (B) Task Force s various working groups and subgroups have been active and making progress on their 2015 charges. He said he has no issues or concerns to report to the Committee at this point in time. Mr. Ostlund said he anticipates presenting to the Committee at the Summer National Meeting proposed revisions to the

Attachment One Health Insurance and Managed Care (B) Committee 8/--/15 Guidance Manual for the Rating Aspects of the Long-Term Care Insurance Model Regulation (Guidance Manual). He said the Long-Term Care Pricing (B) Subgroup is making excellent progress and has targeted the end of June for submitting its recommendations for revisions to the Long-Term Care Guidance Manual (B) Subgroup, which is a joint subgroup of the Health Actuarial (B) Task Force and the Senior Issues (B) Task Force. Mr. Ostlund also noted that the Task Force is working with the Financial Condition (E) Committee to add a footnote to the Supplemental Health Care Exhibit to add a new table to the Part 1 to capture reinsurance, risk corridor and risk adjustment (collectively, the 3Rs ) receivables, payables and receipts by state for individual and small group plans in order to provide regulators with information on receivables and payables for the 3Rs on a state-specific basis for individual and small group plans reported on the Supplemental Health Care Exhibit. e. Regulatory Framework (B) Task Force Mr. Wieske said the Regulatory Framework (B) Task Force is focusing on completing the proposed changes to the Managed Care Plan Network Adequacy Model Act (#74). He noted that, at the Spring National Meeting, the Task Force reviewed initial drafts of proposed revisions to the Accident and Sickness Insurance Minimum Standards Model Act (#170) and its companion regulation, the Model Regulation to Implement the Accident and Sickness Insurance Minimum Standards Model Act (#171). The Task Force set a June 15 public comment deadline to receive comments on the drafts. Mr. Wieske said the Network Adequacy Model Review (B) Subgroup is currently working through the many comments received on the initial draft of proposed revisions to Model #74 during twice-weekly conference calls. The Subgroup is about halfway through the comment document and will begin its discussion of the so-called parking lot issues (i.e., issues on which the Subgroup has deferred discussion) via a conference call to be held June 15. Mr. Wieske said the ERISA (B) Working Group is turning its attention to updating the Health and Welfare Plans Under the Employee Retirement Income Security Act: Guidelines for State and Federal Regulation (ERISA Handbook) now that it has completed its work on the Stop Loss, Self-Funding and the ACA white paper. He said the ERISA Handbook has not been updated in a number of years. f. Senior Issues (B) Task Force Commissioner Kipper said the Task Force has not met since the Spring National Meeting. He said the Long-Term Care Disclosure (B) Subgroup has been meeting and will next meet via conference call June 29 to continue its review of provisions in the Model #640, Model #641 and the Guidance Manual. Commissioner Kipper said the Long-Term Care Partnership Reporting (B) Subgroup has been meeting to discuss what steps are needed to resume the collection of data from long-term care insurance carriers participating in the Long-Term Care Partnership Program. Commissioner Kipper said the Long-Term Care Partnership Reporting (B) Subgroup is considering two options: 1) contacting the HHS about resuming collection of the data; or 2) deciding whether the NAIC could collect and compile the data. He said the Task Force also has reappointed the Medigap (B) Subgroup to consider revisions to the Model Regulation to Implement the NAIC Medicare Supplement Insurance Minimum Standards Model Act (#651) due to the recent enactment of H.R. 2, Medicare Access and CHIP Reauthorization Act of 2015. H.R. 2 amends the Social Security Act, Section 1882 to add a new subparagraph (z) providing that on or after Jan. 1, 2020, no Medicare supplemental policy (or rider) that provides coverage of Part B deductible may be sold or issued to a newly eligible Medicare beneficiary. Commissioner Kipper said it is anticipated that the Medigap (B) Subgroup will meet via conference call at least once prior to the Summer National Meeting. Having no further business, the Health Insurance and Managed Care (B) Committee adjourned. W:\National Meetings\2015\Summer\Cmte\B\B Cmte 6-11-15 ConfCallMin.docx 2015 National Association of Insurance Commissioners 3

Agenda Item #5 Consider Reviving the Medical Loss Ratio Quality Improvement Activities (B) Subgroup NO MATERIALS

August 13, 2015 Commissioner Roger A. Sevigny (NH) Chair of the NAIC Health Insurance and Managed Care (B) Committee National Association of Insurance Commissioners Re: AHIP Support for Reviving the Medical Loss Ratio Quality Improvement Activities (B) Subgroup Dear Commissioner Sevigny, America s Health Insurance Plans (AHIP) appreciates your work as a leader in health insurance regulatory action, and wanted to share our support for the Health Insurance and Managed Care Committee's consideration to reactivate the Medical Loss Ratio Quality Improvement Activities (B) Subgroup. It has been more than 4 years since the final MLR regulations and guidance on quality improving activities have been in place. The NAIC played an important role in establishing those, and has a similar role to play today. While the federal MLR regulation acknowledges many existing efforts to improve quality, it defines health care quality initiatives in a way that is too narrow, creating barriers to investment in the many activities that health plans have implemented to improve health care quality. The next generation of health plan innovations beneficial to enrollees can be inhibited by the MLR regulation s approach of capping any expenses that do not meet the four criteria of activities that improve health care quality. And while the HHS MLR Technical Guidance of May 13, 2011 1 notes that their examples are illustrative, not exhaustive, we have not seen action on that front except for extension of the ICD-10 implementation factor. Health plans have a long track record in developing innovative approaches to payment and delivery system reforms that are helping to ensure greater coordination and less fragmentation in the health care system. These tools and innovations not only produce better clinical outcomes, but also result in significant care cost savings. For example health plans are seek to reduce preventable hospital admissions, readmissions, and emergency room use through a wide range of patient-centered initiatives that focus on rebuilding primary care efforts, medical homes, and engaging patients. 1 https://www.cms.gov/cciio/resources/files/downloads/mlr-guidance-20110513.pdf

August 13, 2015 Page 2 Health plans continue their focus on strategies that advance health information technology, adopt payment models that reward quality and value, encourage clinical decision-making based on best evidence, empower patients to more effectively engage in the health care system, and design benefits that encourage consumers to choose the safest, highest quality and most cost-effective drugs, devices, and procedures. The broad range of strategies used by health plans to contain the rapid escalation of care costs should be encouraged by the MLR regulation, rather than undermined. And though the MLR regulation exempts costs associated with certain quality improvement activities, this exemption may not include vital research and data collection efforts. For example, health plans are increasingly using their own claims databases, and publicly available claims and administrative cost data, to pinpoint indicators of sub-optimal care, such as high rates of hospital readmissions, medical errors and other adverse events, and higher-than-average mortality or morbidity rates. Because this research may not be viewed as directly related to patient outcomes, it would likely be counted toward administrative costs not as a quality improvement activity under the MLR regulation. Therefore, such research could be the first to be eliminated if a health plan s operations were near the MLR threshold. The MLR regulation falls short in another critical way- in only allowing recoveries from fraud programs to be counted toward the MLR, while not recognizing the expenses to prevent or deter fraud. Health plan anti-fraud initiatives are strongly focused on preventing fraud before it takes place, rather than paying and chasing after the fact. This approach serves as a powerful deterrent in preventing not only inappropriate billings, but more importantly, preventing inappropriate delivery of unnecessary or inappropriate services from occurring in the first place. The success of health plans fraud prevention initiatives is evidenced by the fact that government programs now are incorporating these innovative private sector practices, have joined with health insurers and regulators in partnership to address fraud in the Healthcare Fraud Prevention Partnership 2. Given the role that health plan fraud prevention and detection programs have played in establishing effective models for public programs, improved data for law enforcement, and successful prevention efforts, we believe the MLR regulation s treatment of such programs should be reevaluated. Recent focus on medical identity theft, which has been seen in connection with fraud activity, is illustrative of the patient harm fraud represents; and further illustrates the consumer protections and quality of care that strong anti-fraud initiatives provide. 2 https://hfpp.cms.gov/

August 13, 2015 Page 3 These are some of the things we hope to discuss with a revived MLR Quality Improving Activities Subgroup. We would be happy to work toward recommendations that could be considered by your committee. Thank you. Sincerely, C. M. (Candy) Gallaher, SVP State Policy AHIP c/c: Brian Webb, NAIC staff

Agenda Item #6 Consider Adoption of its Subgroup, Working Group and Task Force Reports:

Conference Calls CONSUMER INFORMATION (B) SUBGROUP August 11, 2015 / August 7, 2015 / August 4, 2015/ July 31, 2015 / July 28, 2015 / July 24, 2015 / July 22, 2015 / July 17, 2015 / July 14, 2015 / July 10, 2015 / July 7, 2015 / July 2, 2015 / June 30, 2015 / June 26, 2015 / June 23, 2015 / June 19, 2015 / June 16, 2015 / June 12, 2015 / June 9, 2015 / June 5, 2015 / June 2, 2015 / May 29, 2015 / May 26, 2015 / May 22, 2015 / May 19, 2015 / May 15, 2015 / May 12, 2015 / May 8, 2015 / May 5, 2015 / May 1, 2015 / April 20, 2015 Summary Report The Consumer Information (B) Subgroup of the Health Insurance and Managed Care (B) Committee met via conference call Aug. 11, 2015, Aug. 7, 2015, Aug. 4, 2015, July 31, 2015, July 28, 2015, July 24, 2015, July 22, 2015, July 17, 2015, July 14, 2015, July 10, 2015, July 7, 2015, July 2, 2015, June 30, 2015, June 26, 2015, June 23, 2015, June 19, 2015, June 16, 2015, June 12, 2015, June 9, 2015, June 5, 2015, June 2, 2015, May 29, 2015, May 26, 2015, May 22, 2015, May 19, 2015, May 15, 2015, May 12, 2015, May 8, 2015, May 5, 2015, May 1, 2015 and April 20, 2015. During these calls, the Subgroup: 1. Gathered feedback from individuals with first-hand experience using the summary of benefits and coverage (SBC) template to assist consumers, such as certified application counselors, navigators, insurance agents, and employers large and small. 2. Worked through language to revise the SBC template to meet the U.S. Department of Health and Human Services (HHS) deadline of early September. 3. Adopted a recommendation requesting that the Health Insurance and Managed Care (B) Committee recommend to the Executive (EX) Committee approval of funding for consumer testing of the Subgroup s anticipated revised SBC template. The Health Insurance and Managed Care (B) Committee adopted the Subgroup s recommendation and presented it to the Executive (EX) Committee for consideration of adoption. The Executive (EX) Committee adopted the Health Insurance and Managed Care (B) Committee s recommendation June 12 via conference call for the NAIC to fund and conduct the consumer testing of the Subgroup s revised SBC template after the Subgroup completes its work in August. 2015 National Association of Insurance Commissioners 1

Conference Call MODEL LAW REVIEW INITIATIVE (B) SUBGROUP April 23, 2015 Summary Report The Model Law Review Initiative (B) Subgroup of the Health Insurance and Managed Care (B) Committee met via conference call April 23, 2015. During this meeting, the Subgroup: 1. Adopted recommendations to retain as NAIC models the five NAIC models it was charged to review: the Discount Medical Plan Organization Model Act (#98), the Health Policy Rate and Form Filing Model (Act) (Regulation) (#165), the Prevention of Illegal Multiple Employer Welfare Arrangements (MEWAs) and Other Illegal Health Insurers Model Regulation (#220), the Long-Term Care Insurance Model Act (#640), and the Long-Term Care Insurance Model Regulation (#641). The Subgroup will report its recommendations to the Health Insurance and Managed Care (B) Committee at the Summer National Meeting. 2015 National Association of Insurance Commissioners 1

Attachment? Health Insurance and Managed Care (B) Committee 8/16/15 Draft: 5/5/15 Model Law Review Initiative (B) Subgroup Conference Call April 23, 2015 The Model Law Review Initiative (B) Subgroup of the Health Insurance and Managed Care (B) Committee met via conference call April 23, 2015. The following Subgroup members participated: Tanji Northrup, Chair (UT); Richard Robleto (FL); Molly White (MO); Martin Swanson (NE); and J.P. Wieske (WI). Also participating was: Peg Brown (CO). 1. Adopted Model Law Review Initiative Recommendations Ms. Northrup said the Subgroup received comments from the NAIC consumer representatives, the Florida Office of Insurance Regulation and the Consumer Health Alliance (CHA) on the draft model review initiative recommendations for the five NAIC models the Subgroup was charged with reviewing: 1) the Discount Medical Plan Organization Model Act (#98); 2) the Health Policy Rate and Form Filing Model [Act] [Regulation] (#165); 3) the Prevention of Illegal Multiple Employer Welfare Arrangements (MEWAs) and Other Illegal Health Insurers Model Regulation (#220); 4) the Long-Term Care Insurance Model Act (#640); and 5) the Long-Term Care Insurance Model Regulation (#641). She said the purpose of the conference call is to discuss the comments and to consider adoption of model law review initiative recommendations for the five NAIC models. Jolie Matthews (NAIC) explained the draft model law review initiative recommendations for the five NAIC models. She said that in reviewing the comments received on Model #98, there appeared to be a difference of opinion on whether Model #98 should be retained as an NAIC model or converted to a guideline. The comments received on Model #165 and Model #220 also differed as to whether the models should be retained as NAIC models or archived. Mr. Robleto asked for an explanation as to the status of an archived NAIC model and what is to be considered when deciding to convert an NAIC model to a guideline. Ms. Matthews said an NAIC model that is archived is no longer supported or considered a current NAIC model. She said a few factors are considered when deciding whether to convert an NAIC model to a guideline. One of those factors is the number of states that have adopted the model. Ms. Matthews said another consideration is whether the issue the NAIC model is addressing requires uniformity among the states. She said if uniformity is not required, then guideline status is considered as a best practice that the states can adopt to address the issue. a. Model #98 Ms. Northrup asked the Subgroup members whether they supported retaining Model #98 as an NAIC model or converting it to a guideline. Mr. Swanson said Nebraska is one of the states that have adopted the model. As such, he supports retaining Model #98 as an NAIC model. Mr. Robleto said that although the Florida Office of Insurance Regulation supported converting Model #98 to a guideline, he could support retaining it as an NAIC model. He suggested, however, that the Subgroup s recommendation include suggesting that the model be revised. Mr. Wieske agreed. Ms. White pointed out that the CHA mentioned in its comments that more states have adopted Model #98 than is reflected in the NAIC s state adoption chart. Ms. Brown also expressed support for retaining Model #98 as an NAIC model and revising it in the future. She explained that, currently, discount medical plan organizations are regulated by the Colorado Attorney General s Office, not the Colorado Division of Insurance. However, this could change in the future and if that occurred, it would be helpful to be able to consider adoption of Model #98. Allen Erenbaum (Erenbaum Legal Strategies, Inc.), representing the CHA, said that, as noted in its comment letter, the CHA believes about 33 states have adopted Model #98. If a factor in considering whether an NAIC model should be converted to a guideline is the number of state adoptions, then it is important that the NAIC s information be updated to reflect the actual number of states that have adopted it. Mr. Erenbaum noted that the NAIC s state adoption chart does not indicate that Nebraska or Utah have adopted Model #98, both of which have adopted it. He also noted that although Model #98 includes many options for the states to consider, the states that have adopted Model #98 have done so uniformly. Mr. Erenbaum said that if the Subgroup decides to retain Model #98 as an NAIC model and includes in the recommendation that it be revised, he believes some of the model s options could most likely be eliminated. He also said the CHA has no strong feelings on whether Model #98 be retained as an NAIC model or converted to a guideline, but if the Subgroup s decision to convert it to a guideline is based on the number of states that have adopted the model, then its decision would be flawed because it would be based on inaccurate information. Mr. Erenbaum also expressed support for revising the model and, as part of those 2015 National Association of Insurance Commissioners 1