Health Insurance Association of America

MORE REGULATORY REQUIREMENTS THAN "PARCA"

The Norwood-Dingell-Gephardt-Waxman-Stark "Bipartisan Consensus Managed Care Improvement Act" (H.R. 2723). ("Dingell-Norwood"); the Shadegg-Coburn "Health Care Quality and Choice Act of 1999", (H.R. 2824), ("Shadegg-Coburn"); and the Boehner "Comprehensive Access and Responsibility in Health Care Act of 1999" (H.R. 2926) ("Boehner") contain more new requirements for group and individual health plans than"PARCA." ("PARCA" was Dr. Norwood's discredited "Patient Access to Responsible Care Act of 1997 (H.R. 1415), introduced in the 105th Congress.)

In comparison, both Dingell-Norwood and Shadegg-Coburn contain over 400 new statutory requirements as opposed to over 200 imposed by PARCA's core provisions. Boehner contains 367 statutory requirements.

These new federal statutory requirements will be amplified by additional federal regulatory requirements by the Department of Labor (DOL), the Health Care Financing Administration (HCFA), and the Internal Revenue Service (IRS). By and large, these federal agencies will be authorized to issue regulations "as may be necessary" to implement the hundreds of statutory rules, and to issue "interim final" rules - enforceable regulations without notice and comment in proposed form.

These new federal statutory and regulatory requirements will necessitate an explosive growth in federal bureaucracy. Thousands of new personnel will be required to provide oversight and enforcement of hundreds of new requirements at the federal level alone. PARCA was estimated to require 3,828 new full time federal employees. These bills would likely require more.

State regulation is likely to grow in tandem with oversight and enforcement needs. Generally, states will be permitted to adopt additional requirements so long as the state rules do not prevent the application of the federal requirements. Health plans operating as fully-insured arrangements will be subject to hundreds of state and federal regulations.

__________________________________________

  • Boehner also includes access provisions that are not included in this count.


Health Insurance Association of America

COMPARISON OF NEW LEGAL REQUIREMENTS ON EMPLOYERS/PLAN SPONSORS AND HEALTH PLANS

 

 

PARCA

Dingell/Norwood

Shadegg/Coburn

Boehner

Utilization Review

30

72

73

-0-

Internal Appeals

-0-

31

32

28

External Appeals

-0-

68

71

113

Grievance Process

-0-

15

15

-0-

Point-of-Service

6

4

4

-0-

Provider Selection

8

6

4

-0-

Emergency Care Access

7

10

14

12

Specialty Care Access

2

31

34

1

OB-GYN Care Access

-0-

2

2

2

Pediatric Care Access

-0-

1

1

1

Continuity of Care

11

17

17

13

Network Adequacy

20

-0-

43

-0-

Experimental Drugs

-0-

-0-

4

3

Prescription Drug Access

-0-

6

-0-

-0-

Clinical Trial Access

-0-

10

-0-

10

Information Rules

23

63

60

114

Physician Advice Rules

20

25

25

13

License/Certification Rules

13

4

5

-0-

Physician Incentive Rules

6

2

2

-0-

Prompt Claim Payment

-0-

4

4

-0-

Provider Advocacy Rules

-0-

21

-0-

-0-

Claims Form Rules

-0-

1

1

-0-

Liability Requirements

1

5

10

-0-

Enhanced Remedies

-0-

-0-

-0-

12

New Definitions

9

12

12

28

Discount Disclosure

-0-

-0-

-0-

9

Binding Arbitration

-0-

-0-

15

8

Total New Requirements

200*

408

448

367

* Original PARCA proposal included numerous additional enrollee discrimination, provider discrimination, solvency, and other requirements.


 
 
 
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