The Office of the Insurance Commissioner (OIC) hosted its Health Policy Round Table yesterday, where it outlined its current work and its legislative priorities for the 2019 Legislative Session.
The OIC shared the current proposed rulemaking it is pursuing during the 2018 interim, including three proposed rules that are still being drafted.
The OIC is in the initial stages of drafting a proposed rule to implement SB 6219, which requires coverage for over-the-counter contraception without the need for a prescription.
A proposed rule to update Pharmacy Benefit Manager (PBM) rules is close to completion. The rule will require the use of an online filing interface with a single point of contact and identify protected health information for segregation.
Another proposed rule that is still in the early stages of being developed would require that the OIC web address and hotline number be added to all adverse action notices, such as a claims denial, to increase customer awareness of the OIC as a resource.
2019 Legislative Agenda
The OIC has three main health care related items on its 2019 legislative agenda: surprise billing, MACRA compliance, and cybersecurity.
A bill to end the practice of surprise billing in certain instances failed to pass last session. The OIC has made this legislation a priority for the 2019 session. The OIC hopes to see legislation that would prohibit surprise billing when a patient receives medical care at an out-of-network emergency room for a “true emergency” and when a patient has an approved surgery at an in-network facility, but receives out-of-network services, such as anesthesiology or labs.
The OIC found that on average, patients who are balanced billed pay four to five times the amount that would have been paid if the service was provided by an in-network provider. For example:
- Surgery: $568 out-of-network versus $136 in-network
- Anesthesiology: $649 out-of-network versus $119 in-network
- Radiology: $125 out-of-network versus $28 in-network
In order to remain in compliance with federal statues under MACRA, Washington must pass legislation to allow companies to offer a new Medicare Plan G with a high deductible option and new enrollees after January 1, 2020 will no longer be able to purchase a Medicare Supplement Plan. These changes must be in place by January 1, 2020 so this legislation must pass in the 2019 session.
While the majority of states can comply with only a rule change, the Revised Code of Washington has language pertaining to plan offering and guaranteed issue which must be changed by a statutory change.
The National Association of Insurance Commissioners adopted the Insurance Data Security Model Law in October 2017. The law creates rules for insurers, agents, and other licensed entities covering data security, investigation and notification of a breach.
Only the South Carolina Department of Insurance has adopted the law so far. Ideally, all 50 states will adopt the model law, or a similar version, in order to uniformly protect consumers personally identifiable information.