Update on LBTF and Review of Minimum Healthcare Protection Act

1. Update on LBTF and Review of Minimum Healthcare Protection Act Mike Batte Insure New Mexico! Council August 11, 2005 Department of Insurance

2. Agenda for August 3, 2005Task Force meeting • Review other state efforts • Review of Minimum Healthcare Protection Act • Review possible proposals • Insurer perspective • Next steps Department of Insurance

3. Review of other state efforts • Academy Health (SCI) issues brief • Massachusetts • Maryland • Texas • Washington Department of Insurance

4. Minimum Healthcare Protection Act • Purpose • Eligibility • Managed care features • Required benefits • Required disclosures Department of Insurance

5. Purpose of MHPA “… to address limitations in access to healthcare by authorizing insurers, … to offer minimum healthcare services … at affordable rates to those … who may not desire or be able to afford more comprehensive healthcare services …” Department of Insurance

6. Eligibility • Individuals, families & groups < 20 • Without insurance for six-months (crowd out) • Exceptions • Group not in existence for 6 months • Employer terminates coverage • Change in dependent status • Change in employment Department of Insurance

7. Managed care features • Excludes not medically necessary • Pre-authorization for hospital admission • May include • Network of providers • 2nd opinion for elective surgery • Utilization review • May limit coverage to $50,000 Department of Insurance

8. Required benefits • In-patient hospital, not < 26 days • Pre-natal care • Coverage for delivery • Well baby and well child care • Mammograms • Cytologic screening • Primary care, at least 7 office visits • Childhood immunizations • Smoking cessation Department of Insurance

9. Required disclosure • Written disclosure to applicants • Mandates not covered • Managed care features • Primary care features • Signed written statement of applicant • Certifies eligibility • Acknowledges limited nature • Acknowledges rejection of comprehensive coverage Department of Insurance

10. Review possible proposals • Amend the “Minimum Healthcare Protection Act” • Amend the “HMO Act” • Create a “standard benefit plan” (the Texas approach) Department of Insurance

11. Insurer perspective • Some mandates are costly • Texas example 8% • Anti-discrimination statutes are costly • Unnecessary treatment related to Chiropractic medicine • Unnecessary treatment related to DOM Department of Insurance

12. Next steps • 2 meetings scheduled • Drafts to amend MHPA (HMO?) • Modify anti-discrimination Department of Insurance