Delegate to Congress Donna M. Christensen informs Virgin Islanders that the U.S. Department of Health and Human Services has announced specific clarifications with regards to the implementation of health care reform in the territories.
“We have gotten good news that the territories will be included in the consumer protections and insurance market reforms that we have all fought hard for over the last two years in the health care reform debate. All the territorial delegates and their staff have been in constant negotiations with Secretary Sebelius and her staff ensuring that we will receive “state-like treatment” in major parts of the reforms, for example the coverage of adult children to age 26,”said Congresswoman Christensen..
The HHS clarification also covers important items that prohibit insurers in the territory from:
* denying coverage based on preexisting conditions. This prohibition takes effect for children this year, and for adults beginning in 2014.
* establishing lifetime limits on the dollar value of benefits for any beneficiary. This prohibition takes effect this year.
* establishing annual limits on the dollar value of benefits for any beneficiary. This prohibition takes effect in 2014.
* rescinding coverage to enrollees except in the case of fraud by the beneficiary. This prohibition takes effect this year.
Congresswoman Christensen said that with the HHS clarifications insurers are:
* required to make dependent coverage available to adult children until age 26.
* prohibited from charging higher rates due to a beneficiary’s gender, health status, or age. This prohibition takes effect in 2014.
* required to implement an effective appeals process that meets certain minimum standards, so that patients can appeal decisions like a decision not to cover a claim. This prohibition takes effect this year.
* prohibited from discriminating in favor of higher-wage employees. This prohibition takes effect this year.
* prohibited from establishing eligibility requirements linked to health status-related factors, such as disability. This prohibition takes effect in 2014.
* required to provide coverage for certain preventive health services (such as vaccinations), and cannot require co-payments for these services. This prohibition takes effect this year for new plans and in 2018 for pre-existing plans.
* required to submit a justification for any unreasonable increases in premiums to the state and federal government. This provision takes effect this year.
The congresswoman said that the U.S. territories will benefit from multiple federal grant programs to implement certain of the consumer protections and insurance market reforms established under the Patient Protection and Affordable Care Act. For example, the territories will be able to participate in a $30 million Consumer Assistance Grants program to create and strengthen its consumer assistance office and will be eligible to obtain federal grants to police insurance companies to ensure they are not unreasonably increasing premiums.
“We have been diligent in making sure that the various consumer protections established in this landmark bill will apply to U.S. Virgin Islands and the other territories,” she said. “In June, Resident Commissioner Pierluisi and I met with top HHS officials, including Steve Larsen, the deputy director for Oversight at HHS’s Office of Consumer Information and Insurance Oversight, which is overseeing the implementation of the consumer reforms established in PPACA. Our staffs have been working with House and Senate leadership and with HHS to make these clarifications.”
“It is now up to Governor deJongh and his health reform team to implement the necessary laws and regulations on the territory’s end to ensure that these reforms can effectively work for the good of the Virgin Islands people,” Congresswoman Christensen said.
