General to file a lawsuit challenging the constitutionality of the PPACA, a bill requiring statutory authorization by the General Assembly to implement PPACA, a bill expanding the autism mandate, an MLR bill for large carriers requiring a 90 percent MLR for Missouri-associated revenues and 85 percent for smaller carriers, a bill requiring the state employee health plan to offer a minimum of three high-deductible options with differing annual deductibles and annual out-of-pocket expenses, a bill prohibiting "Most Favored Nation" clauses, legislation creating transparency and publication of carriers' fee schedules and requiring carriers to contract with providers willing to meet certain provider participation terms and conditions, and creation of a uniform group application for insurance.

NEBRASKA: The 102nd unicameral legislature has convened in Lincoln where it is expected to spend much of the session grappling with a budget deficit approaching $985 million for the 2011-2013 biennium. Implementation of the PPACA is expected to receive serious attention as well,

with six bills relating to implementation or rejection of PPACA introduced to date. Bills of interest include legislation creating an Exchange Task Force, an interim committee for PPACA study, and several bills challenging the individual mandate, prohibition of abortion coverage, and a cochlear implant mandate. In addition, a bill banning discretionary clauses in health and disability income insurance contracts has been introduced.  The legislature began its work on January 6 and is tentatively scheduled to adjourn on May 26, 2011.

NEW HAMPSHIRE: The legislature convened on January 5, 2011, and is scheduled to adjourn on June 30, 2011. Governor John Lynch will continue as the state Executive; however, Republicans have gained control of both chambers in the legislature. In addition to the state's budget deficit, implementation of federal health care reform will continue to be a priority for the governor and the legislature. Given the Republican majority and anticipated revenue shortfalls, there will be limited, if any, activity on health insurance issues. The legislature will, however, be paying close attention to federal health reform implementation issues and activities. 

In addition, there have been discussions about eliminating certain state mandates if they are not included in the essential benefits required under the PPACA. In 2010, the state enacted legislation granting certain powers to the commissioner with respect to implementation of PPACA.  This legislation also created a legislative oversight committee, to which the Department of Insurance (DOI) must report monthly. This month the DOI submitted a request for a waiver of the 80 percent minimum loss ratio (MLR) requirement for individual health insurance market policies until 2014.

 NEW YORK: In a new report, the United Hospital Fund (UHF) looks at how New York might set up health insurance exchanges. One option is to let HHS run the state's exchange, While that could save money, it would also mean ceding key operational and regulatory issues to the feds. It might also jeopardize existing consumer protections in Medicaid that are unique to New York. If the state sets up its own exchange, it must decide whether to join a multi-state exchange, a statewide entity, or small local ones. UHF noted that New York might consider following the leads of Massachusetts and California by creating an independent public authority to run an exchange. Former Governor David Paterson created a 35-member Exchange Committee that met only twice and did not make any recommendations. Governor Andrew Cuomo has not indicated his plans for establishing an insurance exchange in New York.

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