Wisconsin's Insurance Commissioner: Request: DENIED

In our June 1 Update newsletter, we covered Wisconsin Commissioner of Insurance Ted Nickel's special request to the Feds asking to side-step private health insurance rate review thresholds under the Affordable Care Act.

In his May 7, 2012 request letter, Commissioner Nickel sought a state specific threshold for rate review. He said that the Affordable Care Act’s rate review threshold of reasonableness was “inappropriate” for Wisconsin. Unfortunately for the Commissioner, his request lacked actuarial data and failed to include any public input. Additionally, Commissioner Nickel’s letter incorrectly characterized the current rate review procedures in Wisconsin. ABC for Health submitted comments to the Feds on Commissioner Nickel's request.
In a letter dated June 1, the Feds replied to Commissioner Nickel, denying his request. They actually said the Commissioner didn't follow the directions. Therefore, the 10% rate review threshold will continue to apply in Wisconsin. The Centers for Medicare and Medicaid Services (CMS) writes:

"CMS has determined that we are unable to accept your proposal because it does not set forth a proposed State-specific threshold to be used to determine rate increase filing that would be subject to review in the State of Wisconsin. Instead, the proposal requested approval for a methodology and permission for the Office of the Commissioner to use the methodology to arrive at a State-specific threshold on its own. This proposed approach is not consistent with the instructions presented in the Guidance, and would not permit the announcement of a State-specific threshold by June 1, as required under 45 C.F.R. 154.200(b)." (emphasis added.)

CMS posted ABC for Health's public comment on their web page.
HealthWatch has been tracking Wisconsin's meager, even hollow attempts at implementing the rate review provision of health reform since spring of 2011 when HHS first announced that the new regulation would take effect on September 1, 2011. Want to learn more? Click here to read a special edition of the HealthWatch Reporter devoted entirely to this issue!