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CMS to Perform Rate Reviews in 10 States

 |  By Margaret@example.com  
   July 21, 2011

Ten states have been notified that the Center for Medicaid & Medicare Services will be taking over responsibility for reviewing certain health insurance premiums increases proposed by insurers in their states.

The move, effective Sept. 1, 2011, is part of Affordable Care Act regulations that require significant rate increases in all states to be reviewed by independent experts and disclosed to the public. CMS had hoped that all states would have their own review programs up and running by September and even earmarked $250 million in grants to get the process underway. But some states don’t have the legal authority or resources to effectively review health insurance rates. In those cases the federal government is stepping in.

In Montana and Idaho politics played a role in limiting the review process preparation. The Montana legislature defeated a bill that would have given its state auditor the authority to review rates and negotiate with insurers. According to the Billings Gazette, the Republican-controlled Legislature “wanted nothing to do with implementing the new federal health reform law.”

In Idaho, Gov. C.L. "Butch" Otter's signed an executive order that prohibits the state from carrying out any component of the ACA, according to reports in the Idaho Statesman.

 

In addition to Idaho and Montana, CMS will handle reviews in the individual and small group market for Alabama, Arizona, Louisiana, Missouri and Wyoming. It will also handle reviews in the small group market for Iowa, Pennsylvania and Virginia; those states will handle their own rate reviews for the individual market.

A CMS spokesperson said the agency will continue to work with the 10 states to align their rate review efforts with ACA regulations, which call for rate increases of 10% or more to be reviewed. Insurers must publically disclose the increases and justify the request to raise premiums.

Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
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