State of NevadaOffice for Consumer Health

Assistance

HEALTHCARE REFORM

Marilyn G. Wills, DirectorMarilyn G. Wills, DirectorGovernor’s Consumer Health AdvocateGovernor’s Consumer Health Advocate

Office for Consumer Health Assistance

Workers Compensation Ombudsman

2001 Legislation Senate Bill 573 – Transferred Bureau for Hospital

Patients to GovCHA Hospital billing issues Jurisdiction: Final determination (NRS 223.575.4)

Office for Consumer Health Assistance

Assembly Bill 236 – Nevada Prescription Help Desk RxHelp4NV.org

Assembly Bill 79 – External Review◦Certified by Division of Insurance◦Final Determination

2005 Legislation Assembly Bill 155 – Requires all Nevada Hospitals to

have GovCHA contact information on all Admission and Discharge forms. (NRS 449.730)

Post discount policy for uninsured.

Office for Consumer Health Assistance

Senate Bill 126 – Requires the Division of Industrial Relations (DIR) to include GovCHA contact information on all notices or forms sent to an injured employee. These include:◦C1 – Notice of Injury or Occupational Disease◦C3 – Employer’s Report of Industrial Injury or

Occupational Disease◦C4 – Employee’s Claim for Compensation/Report of

Initial Treatment◦D1 – Workers’ Compensation Rights and Benefits Poster◦The DIR’s web-site

Office for Consumer Health Assistance

Five years Assist small employer and their employees in

resolving disputes with insurance companies relating to insurance coverage, claims, payments, and reimbursements

Small business employer education and advocacy Small group health plans Health Care Reform

Provision in the Patient Protection and Affordable Care Act of 2010 (Health Care Reform)

Strategic Collaborations ◦ Access to HealthCare Network◦ SHIP◦ RAGE◦ Salud En Accion

Goal is to expand the reach of the office and assist more individuals statewide

2011 – AB519

Moved GovCHA to DHHS, Director’s OfficeTransferred Office of Minority Health from the Health Division to GovCHA – remains as separate programNevada 211 moved under GovCHA umbrellaEstablished GovCHA Director as “Governor’s Consumer Health Advocate”

Office for Consumer Health Assistance

Expands rules for External Review

Establishes Silver State Exchange

HEALTH CARE REFORMPatient Protection and Affordable Care Act•Signed into Law March 23, 2010

Health Care and Education Affordability Reconciliation Act •Signed into Law March 30, 2010

Created to improve access to health insurance and improve overall quality and affordability for all Americans.

Office for Consumer Health Assistance

HEALTH CARE REFORM

Insurers that offer dependent coverage must offer coverage for adult children until age 26, EVEN IF...

no longer lives at home;Is not claimed as a dependent, or;Is no longer a student

Effective September 23, 2010

Office for Consumer Health Assistance

HEALTH CARE REFORMInsurance plans can no longer charge co-pays/deductibles for preventive care screenings (ex: cancer, cholesterol, diabetes)•Grandfathered plans are exempt

Insurers cannot deny coverage to children through age 18 that have pre-existing conditions.•Grandfathered “Individual” plans are exempt from this provision

Office for Consumer Health Assistance

HEALTH CARE REFORMInsurers cannot require higher co-payments/deductibles if the member seeks treatment at an out-of-network emergency room•Grandathered plans are exempt.

Insurers are prohibited from setting dollar limits on the lifetime of the policy; and annual limits on essential benefits are greatly restricted. All plans are affected.

Office for Consumer Health Assistance

Office for Consumer Health Assistance

HEALTH CARE REFORMEarly Retiree Insurance Plan• Provides continued health care

coverage to individuals who retire early but are not yet eligible for Medicare (ages 55-64)

• Apply through employer’s group plan

Small Business Tax Credit• 25 or less employees• If eligible, may receive up to 35% tax

credit Office for Consumer Health Assistance

HEALTH CARE REFORMWhat is a “Grandfathered” Plan?•If a plan was in existence before reform was enacted on March 23, 2010 it is considered to be a “grandfathered” plan.

•Plans are allowed to keep their grandfathered status as long as they do not make any significant changes in coverage. For example:

Significantly increases premiums; Increase medical costs to employees;   Reduces the employer contribution; Significantly cuts or reduces benefits; Adding or tightening an annual limit

The plan loses its grandfathered status and is subject to the provisions in the Health Care Reform Act if any of the above take place. Office for Consumer Health

Assistance

7- Member Voting Board

Governor appoints 5 Senate Majority Leader Appoints 1 Speaker of Assembly Appoints 1

◦ Ex-officio Director of Department of Health and Human

Services Director of Department of Business and Industry Director of the Department of Administration

WEB SITE: govcha.state.nv.us/

E-mail address : cha@govcha.state.nv.us

Office of Consumer Health Assistance555 E. Washington Ave., Suite 4800

Las Vegas, NV 89101702-486-3587 1-888-333-1597

Fax: 702-486-3586

Office for Consumer Health Assistance

MORE INFORMATION ON HEALTH CARE REFORM:www.healthcare.gov