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Regulatory Framework (B) Task Force

2020 PROPOSED CHARGES

REGULATORY FRAMEWORK (B) TASK FORCE

The mission of the Regulatory Framework (B) Task Force is to: 1) develop NAIC model acts and regulations for state health care initiatives; and 2) consider policy issues affecting state health insurance regulation.

Ongoing Support of NAIC Programs, Products and Services

  1. The Regulatory Framework (B) Task Force will:

    1. Coordinate and develop the provision of technical assistance to the states regarding state-level implementation issues raised by federal health legislation and regulations.
    2. Review managed health care reforms, their delivery systems occurring in the marketplace and other forms of health care delivery. Recommend appropriate revisions to regulatory jurisdiction, authority and structures.
    3. Consider the development of new NAIC model laws and regulations and the revision of existing NAIC model laws and regulations, including those affected by federal legislation and final federal regulations promulgated pursuant to such legislation.
    4. Continue to review NAIC models recommended for revision by the former Affordable Care Act (ACA) Model Review (B) Working Group and, as appropriate, appoint a working group or subgroup to revise the NAIC model(s) prioritized for revision in 2020.
    5. At the direction of the Health Insurance and Managed Care (B) Committee, through the work of the ERISA (B) Working Group, monitor, analyze and report developments related to association health plans (AHPs).
    6. Monitor, analyze and report, as necessary, developments related to short-term, limited-duration (STLD) coverage.
  2. The Accident and Sickness Insurance Minimum Standards (B) Subgroup will:
    1. Review and consider revisions to the Model Regulation to Implement the Accident and Sickness Insurance Minimum Standards Model Act (#171).
  3. The ERISA (B) Working Group will:
    1. Monitor, report and analyze developments related to the federal Employee Retirement Income Security Act (ERISA), and make recommendations regarding NAIC strategy and policy with respect to those developments.
    2. Monitor, facilitate and coordinate with the states and the U.S. Department of Labor (DOL) related to sham health plans. 
    3. Monitor, facilitate and coordinate with the states and the DOL regarding compliance and enforcement efforts regarding the ACA that relate to ERISA.
    4. Review the Health and Welfare Plans Under the Employee Retirement Income Security Act: Guidelines for State and Federal Regulation (ERISA Handbook) and modify it, as necessary, to reflect developments related to ERISA. Report annually.
  4. The HMO Issues (B) Subgroup will:
    1. Revise provisions in the Health Maintenance Organization Model Act (#430) to address conflicts and redundancies with provisions in the Life and Health Insurance Guaranty Association Model Act (#520).
  5. The Pharmacy Benefit Manager Regulatory Issues (B) Subgroup will:
    1. Consider developing a new NAIC model to establish a licensing or registration process for pharmacy benefit managers (PBMs). The Subgroup may consider including in the new NAIC model provisions on PBM prescription drug pricing and cost transparency.

 

2019 AMENDED CHARGES

The mission of the Regulatory Framework (B) Task Force is to: 1) develop NAIC model acts and regulations for state health care initiatives; and 2) consider policy issues affecting state health insurance regulation.

Ongoing Support of NAIC Programs, Products and Services

  1. The Regulatory Framework (B) Task Force will:

    1. Coordinate and develop the provision of technical assistance to the states regarding state-level implementation issues raised by federal health legislation and regulations.
    2. Review managed health care reforms, their delivery systems occurring in the marketplace and other forms of health care delivery. Recommend appropriate revisions to regulatory jurisdiction, authority and structures.
    3. Consider the development of new NAIC model laws and regulations and the revision of existing NAIC model laws and regulations, including those affected by federal legislation and final federal regulations promulgated pursuant to such legislation.
    4. Continue to review NAIC models recommended for revision by the former Affordable Care Act (ACA) Model Review (B) Working Group and, as appropriate, appoint a working group or subgroup to revise the NAIC model(s) prioritized for revision in 2019.
    5. At the direction of the Health Insurance and Managed Care (B) Committee, through the work of the ERISA (B) Working Group, monitor, report and analyze developments related to association health plans (AHPs).
    6. Monitor, analyze and report, as necessary, developments related to short-term, limited-duration coverage.
  2. The Accident and Sickness Insurance Minimum Standards (B) Subgroup will:
    1. Review and consider 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).
  3. The ERISA (B) Working Group will:
    1. Monitor, report and analyze developments related to the federal Employee Retirement Income Security Act (ERISA), and make recommendations regarding NAIC strategy and policy with respect to those developments.
    2. Monitor, facilitate and coordinate with the states and the U.S. Department of Labor (DOL) related to sham health plans.
    3. Monitor, facilitate and coordinate with the states and the DOL regarding compliance and enforcement efforts regarding the ACA that relate to ERISA.
    4. Review the Health and Welfare Plans Under the Employee Retirement Income Security Act: Guidelines for State and Federal Regulation (ERISA Handbook) and modify it, as necessary, to reflect developments related to ERISA. Report annually.
  4. The HMO Issues (B) Subgroup will:
    1. Revise provisions in the Health Maintenance Organization Model Act (#430) to address conflicts and redundancies with provisions in the Life and Health Insurance Guaranty Association Model Act (#520).
  5. The Pharmacy Benefit Manager Regulatory Issues (B) Subgroup will:
    1. Consider developing a new NAIC model to establish a licensing or registration process for pharmacy benefit managers (PBMs). The Subgroup may consider including in the new NAIC model provisions on PBM prescription drug pricing and cost transparency.
Related NAIC Publications

Contacts

Media Inquiries
(816) 783-8909
news@naic.org


Jolie H. Matthews
Senior Health Policy Advisor & Counsel
Phone: 202-471-3982

Jennifer R. Cook
Senior Health Policy & Legislative Analyst & Counsel
Phone: 202-471-3986

Please see the current Committee List for a complete list of committee members.

 

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