Health Choices Administration

Monday, December 14, 2009

The Health Choices Administration Commissioner, Inspector General For The Health Choices Administration, and the Ombudsman for the health choices administration are responsible for the overall day-to-day operation and administration of the agency under the oversight of Congress and in cooperation with State attorneys general ,insurance regulators, National Association of Insurance Commissioners, appropriate State agencies, Federal Trade Commission, other, Federal agencies, and Indian tribes and tribal organizations.

The Health Choices Commissioner and the Inspector General For The Health Choices Administration are both appointed by the President and confirmed by the Senate. The Ombudsman is appointed by the Commissioner. (I am sure the Commissioner will “consult” with the President and others concerning this appointment. Conceptually, this means that as Presidents come and go, these officials may also so change and so may the “flavor” of the agency?)

The Commissioner’s role will be to establish qualified heath care plan standards, the Health Insurance Exchange, and individual health insurance affordability credits. In addition, the Commissioner is required to promote accountability on the part of those entities offering health care coverage (carriers, providers, plan sponsors), conduct compliance examinations and audits, and recover the of costs of those examinations and audits. (I assume this will be through monetary penalties?)

A major function of the Commissioner will be to collect data, data on plans offered, procedures covered, financial aspects of plans, … etc. This will be used for various reasons including the measurement of the agency’s success or failure in “promoting quality and value, protecting consumers, and addressing disparities in health care”. Along with collecting data, the Commissioner is charged with the setting of standard medical definitions and terms.

By direction, the Commissioner is required to consult, coordinate, and cooperate with numerous Federal, State agencies and regulatory bodies in an effort to deliver effective and efficient enforcement of the Act’s administration. While this may sound somewhat negative, the Commissioner is required to “achieve uniform standards that adequately protect consumers … that does not unreasonably affect employers and insurers”.

The Act creates a Commissioner and an Inspector General, but then a Health Insurance Ombudsman is also created. The Ombudsman is responsible for receiving complaints and providing assistance, presumably from and to consumers, i.e., the public and to do so in a “linguistically appropriate manner”. In addition, the Ombudsman will be responsible for submitting annual reports to both Congress and the Commissioner.

How long is it going to require for the Commissioner to pull together the various and numerous bodies he has to consult, coordinate, and cooperate with in order to come up with a workable solution to the current health care system? As carriers, providers, and plan sponsors; are we going to be faced with one, two or more years before final rules and regulations are published?