NCQA Pushes for Clarity in HIX Proposed Rules

Cheryl Clark, October 3, 2011

With proposed rules governing each state's health insurance exchanges under review, a prominent quality organization is urging the Centers for Medicare & Medicaid Services to make sure that employers and the public can understand what they are buying.

Left on their own, "we don't think these (state) exchanges will come up with common levels of quality" that enable consumers to make appropriate comparisons, said Sarah Thomas, Vice President of Public Policy and Communications for the NCQA, the National Committee on Quality Assurance

For example, she said, it's important that the exchanges provide comparison information that includes not just the monthly premiums, but other costs such as co-pays, deductibles, and share of costs, all of which could significantly affect the total price tag of each benefit plan.

"Value is not just about low premiums, but instead both total costs and high quality care together," the organization said in a Sept. 28 letter to the Centers for Medicare & Medicaid Services. "It is critical to make clear that low premiums can mask low quality. Low premiums also can mislead consumers who do not understand that low premium plans may have higher cost sharing that can be a serious barrier to affordable, quality care."

The Patient Protection and Affordable Care Act required CMS to establish rules by which each exchange should be run. The 36-page proposed rules were published in the Federal Register Aug. 17, and the public has until Oct. 31 to submit comments.

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