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In the latest round of Essential Health Benefits (EHB) news, the Washington Office of the Insurance Commissioner (OIC) published a proposed rule outlining the state’s benchmark selection and dental supplement. i.e. Children’s Health Insurance Program (CHIP). The proposed rule reverses the approach to dental from a previous exposure draft, which designated the dental benefits that were included in the medical benchmark Regence Direct Gold plan.

MonthlyByte     November 2015   CMS Posts 2016 Plan Data Spreadsheets   The Centers for Medicare and Medicaid Services (CMS) has posted updated data tables on carriers offering Qualified…

This month, NADP and the Delta Dental Plans Association (DDPA) released extensive summaries of the Centers for Medicare and Medicaid Services (CMS) Medicaid Managed Care Rule with specific information on impacts to dental benefits and the states.

July 2016 became one of the most successful months for NADP advocacy efforts. After three years of consistent campaigns, the Internal Revenue Service released an updated proposed regulation to clarify the dental calculation for the Advanced Premium Tax Credit (APTC). While IRS almost never revisits or amends regulations, NADP did not falter and instead pulled together a coalition of consumers, providers and carriers, which continued to pursue advocacy efforts, eventually leading to the recent IRS change.

The Government Relations Workgroup continues to monitor and review legislation of interest to the dental benefits industry, including a National Conference of Insurance Legislators (NCOIL) model act and bills focused on prior authorization and network leasing.

The Government Relations Workgroup (GRW) continues to monitor state activity in response to the COVID-19 pandemic as well as watching for the resumption of regular legislative activity in the states. Many state legislatures have either adjourned early for the year or temporarily suspended their activities because of the pandemic, but some plan to reconvene in the next few weeks;

On May 22, Politico reported that a final rule on the repeal of 1557 taglines is imminent. The rule would remove requirements that dental plans post taglines in the 15 most spoken languages in a state for all “significant communications” and would revert tagline requirements to previous standards.

House Energy and Commerce Committee Chairman, Frank Pallone (D-NJ), announced that he would launch an investigation into health and dental insurance companies’ business practices following reports of higher profit margins, particularly for health insurance companies, during the COVID-19 pandemic.

On Oct. 15, CMS announced it completed the review process for the Georgia Access Model ACA Section 1332 waiver and approved it. The waiver ends the use of the Federally Facilitated Exchange (FFE) in Georgia and creates a reinsurance program for qualified health plans. In the absence of a centralized exchange, plans and brokers will assume expanded roles in marketing, IT, and re-enrollment.

March is the month for annual updates to the NADP database and membership directories.