1. Kristin Leighty, Government Affairs Coordinator, NAHU
Legislative Update
August 10, 2011
Kristin Leighty, Government Affairs Coordinator, NAHU

2. NAHU Government Affairs team
Laurel Call, Sr. Vice President and Counsel – Regions 6 & 8
Jessica Waltman, Sr. VP of Government Affairs – Region 2
Pam Mitroff, Director of State Affairs – Illinois, West Virginia, Regions 4 & 7
Brooke Bell, Director of State Affairs – Region 1, 3 & 5
Kristin Leighty, Government Affairs Coordinator

3. MLR and H.R. 1206 Co-sponsor total sits at 113!
Keep the pressure on while members of Congress are in their home districts!
Sen. Mary Landrieu (D-LA) Sends Letter to HHS
Letter highlights MLR’s negative impact on agents and brokers and includes a direct ask to delay the inclusion of agent compensation in the MLR calculation
Signifies a huge step highlighting the increasing awareness of this issue in the Senate
NCOIL votes unanimously to endorse 1206!
Looking ahead…

4. Status of MLR State Waivers
HHS Recently Approves Two More State MLR Waivers
Iowa and Kentucky join the ranks of approved states
North Dakota Becomes First State to be Denied Waiver
Territory of Guam receives denial letter as well
Texas and Michigan Become Next States to Apply
TX asks for graduated increase of 71% in 2011, 74% in 2012, 77% in 2013 and 80% in 2014
MI asks for 65% in 2011, 70% in 2012, 75% in 2013 and 80% in 2014
Scoreboard:
Approved: ME, NH, KY, NV, IA
Denied: ND
Pending Applications: DE, FL, GA, IN, KS, LA, TX and MI

5. Exchange Developments
Exchange Guidance Finally Released!
July 11 the highly anticipated proposed regulations were released
NAHU Staff and Exchange Working Group continues to analyze the regulations
NAHU has prepared a chart highlighting provisions impacting agents/brokers
Proposed rules will undergo a 75 day comment period
Other Pending State Exchange Action
While legislatures are out of session many governing boards and exploratory committees continue to meet and make progress on state exchange action
NAHU state affairs staff continues to work closely with states to steer them in the right direction
Kansas returns early innovator exchange grant funds to HHS
Scoreboard:
Signed-13 (CA, CO, CT, HI, IL, MD, ND, NV, OR, VA, VT, WA, WV
On Hold-9 (DC, ME, MN, NE, NC, NH, NY, PA, TX)
Dead/Vetoed-11 (AK, AZ, AR, IN, MO, MT, NE, NM, OK, RI, SC)
Work Arounds-8 (AL, GA, IN, IA, KS, MS, OH, WI)
Joel Ario (HHS) stepping down

6. PCIP’s Broker Registration Process Opened
Federal Pre-existing Condition Ins Plan (PCIP) has now finalized its online registration process for agents/brokers
In May, the administration announced it would begin compensating agents and brokers for connecting eligible people with the PCIP program by October 1
Registration of qualified agents/brokers is now open and a $100 flat enrollment fee will be paid in conjunction with successful enrollment of individuals effective September 1.
To qualify for participation you must:
Be an insurance agent or broker in good standing in your state.
Your license must be confirmed through the NIPR database.
Submit a completed W-9 form.
Hold a valid federal tax identification number (FTIN) or social security number (SSN).
Submit a completed EFT form for electronic payment.
Agree to accept payments via EFT.
PCIP broker referral program only applies to 23 states where the federal Gov runs the PPACA high risk pool program

7. HHS Could Assume External Review Process
HHS issued its preliminary list of states not meeting the external appeals review requirement of PPACA
23 states already have laws on the books that meet the strict standards
10 states have similar standards that insurance companies will have to abide by until they bring their standards up to par by Jan. 1, 2014.
Appeals process for the rest of the states and five territories will be assumed by HHS or contract with an independent review organization.
States not in compliance include:
AL, AK, DC, FL, GA, LA, MA, MS, MT, NE, NH, ND, OH, PA, TX, WV, WI
All states have until Oct. 1 to appeal their HHS determination

8. Other News…
HHS Issues Rules on Preventive Care for Women
Proposed Rule Released Regarding Health Insurance Cooperatives (CO-OP Plans)
Coalition Activity
ACO Working Group

9. Next Legislative Update:
THANK YOU!!
Next Legislative Update:
September 14 at 1:00PM EST