The U.S. Department of Health and Human Services (HHS) will publish an interim final rule (pdf) that details the types of information it plans to request from health insurance issuers, states, associations, and high risk pools to create an internet website (“web portal”) through which individuals and small businesses can obtain information about available health insurance coverage options. The recently enacted Patient Protection and Affordable Care Act (PPACA) mandates that the agency establish this web portal by July 1, 2010, although HHS anticipates that the portal will be a work in progress. According to HHS, this web portal is designed to “empower consumers by increasing informed choice and promoting market competition.” At a minimum, this web site will provide access to information on the following types of coverage options: health insurance coverage offered by health insurance issuers; Medicaid coverage; Children's Health Insurance Program (CHIP) coverage; State health benefits high risk pool coverage; coverage under the high risk pool created by section 1101 of PPACA; and coverage within the small group market for small businesses and their employees.

To that end, HHS will begin collecting information from health insurance issuers to create this web portal. Rollout of this site will be in two phases. By July 1, the agency intends to collect an initial set of data (health insurance product information) from issuers in order to publish basic information on all issuers and health insurance products. By October 1, 2010, HHS plans to provide the public with access to more comprehensive pricing and benefit information for individual and small group coverage.

For the initial rollout, the interim final rule stipulates that on or before May 21, 2010, health insurance issuers are to provide to the agency corporate and contact information, such as corporate addresses and websites; administrative information, such as enrollment codes; enrollment data by product; product names and types, such as Preferred Provider Organization (PPO) or Health Maintenance Organization (HMO); whether enrollment is currently open for each product; geographic availability information, such as product availability by zip code or county; customer service phone numbers; website links to the issuer website, brochure documents such as benefit summaries, and provider networks; and financial ratings, such as those offered by financial rating firms including AM Best, Standards and Poor, and Moody’s, if available. HHS invites comments as to whether such enrollment information is considered by issuers to be confidential business information. The above data must be submitted “in accordance with instructions issued by the Secretary.” The rule explains that for data submission for the individual and small group markets, parties will need to establish accounts with HHS through which they can electronically submit data through a template created by HHS. According to the interim rule, a webinar on this process is scheduled on or about May 7. In addition, technical support will be provided through a HHS help desk.

Pricing and benefit information must be submitted on or before September 3, 2010, and annually thereafter, to be included in the October web portal update. Issuers will be required to update their pricing and benefit data for their portal plans whenever they change premiums, cost-sharing, types of services covered, coverage limitations, or exclusions for one or more of their individual or small group portal plans.

Additionally, the rule requires that issuers submit administrative data on products and portal plans, and these performance ratings, percent of individual market and small group market policies that are rescinded; the percent of individual market policies sold at the manual rate; the percent of claims that are denied under individual market and small group market policies; and the number and disposition of appeals on denials to insure, pay claims and provide required pre-authorizations, for future releases of the web portal in accordance with guidance issued by the HHS Secretary.

The health insurance issuer’s CEO or CFO will be required to electronically certify to the completeness and accuracy of the information submitted by October 1, 2010, and whenever future updates are made.

As part of this web development process, the agency seeks comments on how to achieve a balance between “the need to obtain information that will promote informed choice” and the burden of providing this information. HHS is particularly interested in comments on “how to reduce unnecessary burdens on the private sector,” and on any other way to make improvements.

Comments on this interim final rule must be received by June 4, 2010, and contain the identification number: DHHS-9997-IFC. Written comments may be sent to: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: DHHS-9997-IFC, P.O. Box 8014, Baltimore, MD 21244-8014. Hand-delivered comments can be brought to: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., Washington, DC 20201, or the Baltimore location: Centers for Medicare & Medicaid Services, Department of Health and Human Services, 7500 Security Boulevard, Baltimore, MD 21244-1850. Baltimore hand-deliveries must be scheduled in advance by calling: (410) 786-9994. In the alternative, comments may be submitted electronically via the federal eRulemaking portal: www.regulations.gov.

This entry was written by Ilyse Schuman.

Photo credit:  YanC