Health system change trauma is affecting efforts by a National Association of Insurance Commissioners team to complete a supplement to health insurers' annual report forms.
Blanks Working Group at the NAIC, Kansas City, Mo., is trying to help implement the new Affordable Care Act – the federal legislative package that includes the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act – by producing a new supplement and instructions for recording individual, small group and large group major medical health insurance business.
The supplement should help state insurance regulators implement ACA minimum loss ratio provisions that will require insurers to spend 85% of large group premiums and 80% of individual and small group premiums and medical care and quality improvement activities.
In a column for recording "health care quality improvement" expenses, for example, the working group has suggested that insurers should exclude costs related to complying with the shift to the ICD-10 system – a new system for classifying patient diagnoses and procedures.
Candy Gallagher, a vice president at America's Health Insurance Plans, Washington, has blasted the decision to have insurers exclude ICD-10 conversion expenses from the quality improvement column.
The new ICD-10 requirement, which will take effect Oct. 1, 2013, "imposes costs on insurance companies that will be in the billions of dollars over the next 3 years," Gallagher writes. "This represents an unusual spike in costs at a time when health plans struggle to find ways to keep health care premiums down and maintain low administrative expenses."
