State Insurance Commissioners Research Articles

Enforcement of the Mental Health Parity and Addiction Equity Act: State Insurance Commissioners' Statutory Capacity.

State insurance departments enforce the federal Mental Health Parity and Addiction Equity Act (MHPAEA) for fully insured employer-sponsored health plans and plans on the individual marketplace. Variable enforcement among states may drive patients' difficulties in accessing behavioral health treatment. This study explored insurance commissioners' statutory capacity for enforcing the MHPAEA. Legal mapping of insurance office powers and responsibilities was conducted for MHPAEA-enforcing states. Relevant state laws and regulations were gathered from the Westlaw database. Sections were coded in the categories commissioner selection, frequency of examinations, fines, licenses, subpoenas, investigations and hearings, rehabilitation or liquidation of insurers, and initiation of legal actions. The sample included 450 sections of states' codes and regulations. The 46 states that enforced the MHPAEA showed only small differences in the powers and responsibilities of insurance commissioners. Similarities across states in statutory capacity of commissioners suggest that it is not a primary source of variation in MHPAEA enforcement.

APA’s Government, Policy, and Advocacy Update

Back to table of contents Previous article Next article APA & MeetingsFull AccessAPA’s Government, Policy, and Advocacy UpdateSearch for more papers by this authorPublished Online:12 Jan 2021https://doi.org/10.1176/appi.pn.2021.1.36APA’s Department of Government Relations works all year to advocate at the federal and state levels to advance the profession of psychiatry and promote high-quality care for patients. Psychiatric News is starting this regular column to bring you news of APA’s latest advocacy and government relations work.Congress Passes APA-Supported Mental Health Parity Compliance LegislationIn its massive year-end appropriations and COVID relief funding package, Congress passed the Strengthening Behavioral Health Parity Act (HR 7539), for which APA has been advocating for two years. It gives the U.S. Department of Labor (DOL) new powers to regulate and audit health plans to determine if they are in compliance with the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA). President Donald Trump signed the legislation on December 27.The legislation applies to federally regulated ERISA plans as well as state-regulated insurance plans. Among its provisions, the legislation requires plans to perform comparative analyses of their mental health/substance use and medical/surgical benefits and send those analyses to the DOL or a state insurance commissioner in response to complaints or violations. It also requires that Congress receive an annual report identifying plans that are out of compliance with MHPAEA.Congress’s year-end funding package and COVID relief legislation contains several provisions that support mental health programs and initiatives in addition to the new parity law, including: $6 billion for the Substance Abuse and Mental Health Services Administration and $35 million for crisis care and coordination within the Mental Heath Block Grant, as well as increases in funding for several federal agencies that conduct mental health and substance use research.APA Reaches Out to President-elect Biden and Vice President-elect HarrisIn early December, APA CEO and Medical Director Saul Levin, M.D., M.P.A., sent a letter to President-elect Joe Biden and Vice President-elect Kamala Harris, congratulating them on their win and urging them to prioritize responding to the country’s increased demand for psychiatric services. The letter outlined several recommendations for Biden’s first 100 days in office, including improving access to treatment and investing in the mental health system.APA Prepared to Work With States to Introduce Model LegislationAs many states begin their legislative sessions this month, APA is working closely with district branches across the country to protect patient safety and introduce APA’s model legislation.Late last year, APA and its partner organizations finalized model legislation to enforce the holding of the Wit v. UBH decision. The Jim Ramstad Model State Parity Legislation would ensure health plans cover medically necessary care that aligns with practice guidelines and treatment criteria developed specifically by associations like APA. It is similar to legislation that was signed into law in California last year.APA is also working with states to introduce the Psychiatric Collaborative Care model legislation, which would require private insurers to reimburse collaborative care billing codes, and the telehealth model legislation, which would ensure fair reimbursement for psychiatrists who provide telehealth, as well as audio-only service delivery. Half the states have expressed interest in the telehealth model legislation already. APA members interested in learning more can contact APA’s director of state government relations, Erin Berry Philp. ■ ISSUES NewArchived

Groundbreaking Court Ruling Against Insurer Offers Hope in 2020

Groundbreaking Court Ruling Against Insurer Offers Hope in 2020

A survey of U. S. state insurance commissioners concerning genetic testing and life insurance: Redux at 27.

Nearly three decades ago, scientists set out on one of the largest research endeavors in modern history-mapping the human genome. The research not only sparked new technologies and genetic tests, but also concomitant concerns regarding ethical, legal, and social implications of the technologies. These developments ultimately resulted in an expanded role for genetic counselors to educate consumers about the possible consequences of receiving genetic test results. In particular, many individuals undergoing testing worry that the resulting information could be used by social actors, such as life insurers, in harmful ways. Because life insurance is regulated at the state level, there is significant variability across the United States in laws and enforcement protecting consumers' genetic information. This article reports the results of a survey of U.S. state insurance commissioners regarding regulation of genetic testing and life insurance. The survey builds on a 1992 survey conducted by Jean E. McEwen et al. It returns to current U.S. state insurance commissioners to investigate changes in the climate surrounding genetic information use and risks of misuse within the insurance industry. In their 1992 survey, McEwen et al. found that: (a) genetic testing was not yet perceived to pose a significant problem for insurance rating, (b) life insurers had quite a bit of legal freedom to require and use genetic test results, and (c) insurance commissioners had received few consumers' complaints about the use of genetic information. Twenty-seven years later, our survey finds an increase in regulation protecting genetic information in insurance, but at a pace much slower than that of advances in new DNA technologies. This lag in policy to match technology increases potential risks for consumers. Our study further reveals certain inconsistencies in the letter of state law protecting consumers' genetic information and how state insurance commissioners apply that law. The study also shows that despite empirical evidence in the literature demonstrating consumer fear about genetic discrimination, consumers do not report these concerns to their state insurance commissioner. We suggest genetic counselors are key stakeholders who can help fill current gaps between consumers and the insurance industry.

Connecticut mental health parity bill signed into law

Beginning in 2021, Connecticut insurance providers will have to submit annual reports detailing their coverage of mental health and substance abuse services, we‐ha.com reported July 8. The push toward greater transparency is aimed at ensuring the companies comply with state and federal mandates that bar them from placing greater restrictions on access to mental health services than on surgical or medical care. Gov. Ned Lamont on July 8 signed into law the bill that requires the providers to turn in yearly reports about their coverage. Reports on services covered next year are due to the state insurance commissioner in March 2021. In April 2021, the commissioner will share the records with the legislature's Insurance and Real Estate Committee, the attorney general, the state health care advocate and the head of Connecticut's Office of Health Strategy. The following month, the insurance committee may hold a public hearing on the reports. The new law does not include penalties for noncompliance, but advocates say the public scrutiny should provide an incentive.

The American Society for Preventive Cardiology.

The American Society for Preventive Cardiology (ASPC) has started 2018 with noteworthy initiatives. A recap of just a few will be beneficial for members, as well as nonmembers, who will hopefully be inspired to join our burgeoning society. First, we have continued and augmented our Town Hall Series exploring and solving medication access problems in the United States. The 2016 and 2017 meetings were an extraordinary success as we led the nation in the mission to help appropriate patients gain access to PCSK9i, while simultaneously creating methods to ease the massive burdens on our offices. Continuing such advocacy efforts, the ASPC organized 5 programs in 2018 to convene at the American College of Cardiology (ACC), PriMed California, ASPC, Cardiometabolic Health Congress, and the American Heart Association meetings. We hope to see many of you there, so you can share your opinions and also learn to use the tools we have recently developed to help you and your patients. Second, eager to tear down silos separating diverse medical disciplines, the ASPC founded the American Society for Preventive Cardiology Collaborative Action Group (ACAG). Our inaugural meeting was held at the 2018 ACC meeting, where 20+ groups met to discuss issues seemingly specific to their fields, yet actually sharing a commonality with others. The ACAG mission is to facilitate collaboration among varied groups, helping one another amplify their respective missions. ACAG will not launch its own initiatives; it exists solely as a facilitative pipeline of communication and amplification. Third, ASPC created a robust mobile app designed to help clinicians navigate the complex insurance world, thereby ensuring that your patients receive the medications you have prescribed. We began with the PCSK9i, as these medicines have seen unprecedented insurance barriers, making access to them often impossible. The app contains invaluable resources such as a 10-step guide to success, single-page prior authorization and appeal letters, contact information for all state insurance commissioners, links to other helpful resources, and much more. We will soon add similar solutions for heart failure and diabetes medications. Please know that we always welcome suggestions to improve—or add additional functionality to—the app. I would encourage everyone to download the app and then “join” it. You will find it at the Apple App Store: https://itunes.apple.com/app/id1357143692, and the Google Play Store: https://play.google.com/store/apps/details?id=com.aspc.conf4cvaob. In closing, I invite everyone to view the agenda for the 2018 ASPC Congress at the Tamaya Resort, Santa Ana Pueblo, New Mexico (https://www.aspconline.org/congress2018). The Congress will host some of the world's leading authorities in their respective fields. It will provide an unparalleled educational experience in a relaxing setting, which is the ultimate aim of all our annual meetings. Please join us; you will not be disappointed. Wishing you well,

Financial crises at insurance companies: learning from the demise of the National Surety Company during the Great Depression

This article explores the economic issues related to financial crises at insurance companies, using an example from the Great Depression, the National Surety Company. National Surety was a large and diverse American insurance company that experienced a major crisis in 1933 due to losses from its guarantees of mortgage-backed securities. I find that policyholders were able to stage a massive run on the company by demanding the return of their unearned premiums. A key dynamic of the crisis was that policyholders at an insurance company have a dual role as holders of liabilities and as providers of income. In addition, I establish that government officials believed National Surety to be systemically important, due to the size of its insurance business and because many of its counterparties were societal actors that these officials sought to protect. As a result, the New York State Insurance Commissioner used emergency powers to reorganize the company, with the goal of providing continuity to its business lines outside mortgage-backed security insurance.

Enforcement of Parity Law Broadens to Include New Areas of Insurer Violations

Enforcement of Parity Law Broadens to Include New Areas of Insurer Violations

Content Analysis of Cyber Insurance Policies: How Do Carriers Write Policies and Price Cyber Risk?

Data breaches and security incidents have become commonplace, with thousands occurring each year and some costing hundreds of millions of dollars. Consequently, the market for insuring against these losses (aka cyber insurance) has grown rapidly in the past decade. However, very little is known about these policies and the mechanisms behind the risk assessments. While there exists much theoretical literature about cyber insurance, very little practical information is publicly available. For example, what losses are actually covered by cyber insurance policies, and what are the exclusions? What factors are used to compute the premiums, and how do existing underwriting approaches reflect the technical rate of risk? In this research, we collect and analyze over 100 cyber insurance policies filed with state insurance commissioners. By analyzing these policies, we provide the first-ever analysis of the underwriting process for cyber insurance and uncover how insurance companies understand and price cyber risks.

The Resolution of a Systemically Important Insurance Company during the Great Depression

This paper explores the economic issues related to systemically important insurance companies, using an example from the Great Depression, the National Surety Company. National Surety was a large and diverse insurance company that experienced a major crisis in 1933 due to losses from its guarantees of mortgage-backed securities. A liquidity crisis ensued, as policyholders staged a massive run on the company, demanding the return of their unearned premiums. The New York State Insurance Commissioner stepped in with a reorganization plan that split the company in two, out of fear that a disorderly liquidation would have systemic consequences given the sheer number of the company's counterparties, scattered all across the United States. A key dynamic of the crisis was that policy holders at an insurance company have a dual role as holders of liabilities and as providers of income.

APA Presses for Enforcement of Mental Health Parity Law

APA Presses for Enforcement of Mental Health Parity Law

Financing of employer sponsored health insurance plans before and after health reform: What consumers don’t know won’t hurt them?

This paper studies the potential impact on consumers of regulatory arbitrage based on financing of employment-based health insurance plans in the United States. Consumers enrolled in self-insured health plans, for which employers are financially responsible for medical claims, make up a majority of Americans with employer-sponsored health coverage. Unlike their fully insured counterparts, self-insured plans are not subject to state health insurance regulation. They are also exempt from certain provisions in the Patient Protection and Affordable Care Act (ACA). Employers who offer health plans can thus avoid certain insurance regulations and consumer protections by electing to self-insure. This research explores the impact of self-insurance on consumer welfare and how that is expected to change under the ACA. We describe the major consumer concerns regarding self-insurance – firm financial solvency, benefit generosity and stability, claims adjudication and recourse options – and present qualitative and quantitative evidence on their importance. We find a substantial degree of similarity between self-insured and fully insured plans with regard to benefit generosity and stability, at least with respect to available measures. In addition, we find no evidence that enrollees in self-insured plans face higher denial rates. While the ACA will not directly affect claims adjudication, it will improve recourse options for consumers with all plans and narrow the regulatory differences that existed between financing types. Policymakers must work to ensure the transparency of recourse options for enrollees in self and fully insured plans. In terms of financial solvency, while stop loss coverage is more common among smaller versus larger self-insured firms and such coverage typically commences at lower attachment points for smaller firms, roughly one-fourth of self-insured firms with fewer than 200 employees do not have such coverage. The ability of small firms without stop loss coverage to manage the risks associated with health care claims is uncertain, as are the consequences of health care expenditure-related risk for the overall financial solvency of the firm. Further, the financial security of firms who purchase stop loss coverage, and – by extension, the solvency of health plan benefits provided to employees – depends critically on the reliability of the stop loss insurer. State insurance commissioners may want to carefully consider the adequacy and appropriateness of their regulatory oversight of stop loss insurers in light of the potential move among smaller employers into the self-insured and stop loss marketplace.

New Payment Advocacy Information: Document Offers Valuable Information to SLPs, Health Plans

You have accessThe ASHA LeaderASHA News1 Jun 2011New Payment Advocacy Information: Document Offers Valuable Information to SLPs, Health Plans Becky Sutherland Cornett andPhD, CHC Neela Swanson Becky Sutherland Cornett Google Scholar More articles by this author , PhD, CHC and Neela Swanson Google Scholar More articles by this author https://doi.org/10.1044/leader.AN1.16072011.1 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In http://www.asha.org/Publications/leader/2011/110607/New-Payment-Advocacy-Information--Document-Offers-Valuable-Information-to-SLPs,-Health-Plans.htm New guidelines that detail the profession of speech-language pathology and the medical necessity of treatment are now available online. Speech-Language Pathology Medical Review Guidelines is designed for use by two different groups: members advocating for better health plan coverage and policy changes, and health plan officials reviewing claims and developing reimbursement policies. The document is a comprehensive resource containinag information about provider qualifications, services, standard practices, documentation of services, and treatment efficacy. The medical review guidelines are intended for use by health plan medical directors, health plan claims reviewers, and representatives from state insurance commissioner offices, as well as individuals seeking information to justify the validity of claims for reimbursement. ASHA members can use the guidelines to advocate with health plans for improved coverage or policy changes related to speech-language pathology services. Medical review guidelines are documents that describe specific disorders. Private and public health plans (such as state Medicaid agencies) use the information in medical review guidelines to make coverage and payment decisions for health care services, including those provided by speech-language pathologists. The guidelines were created in accordance with a resolution adopted by the Board of Directors in 2008 to address inaccurate medical review guidelines related to speech-language pathology published by other organizations. The Board called for development of speech-language pathology medical review guidelines that include clear and correct information written by experts in the profession. The resulting Ad Hoc Committee on Speech-Language Pathology Medical Review Guidelines, consisting of SLPs Becky Cornett (chair), Diane Ross, Lynne F. Harmon, Gretchen Bebb, and Pat Ford, developed the document in conjunction with Janet McCarty, private health plans advisor, and Neela Swanson, health care financing information coordinator. Thomas J. Hallahan, vice president for government relations and public policy, served as Board liaison and monitoring officer; Steven C. White, director of health care economics and advocacy, served as consultant. Author Notes is the director of fiscal integrity in finance administration at The Ohio State University Medical Center (Columbus) and a member of the ASHA Health Care Economics Committee. Contact her at [email protected]. health care financing information coordinator, can be reached at [email protected] Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 16Issue 7June 2011 Get Permissions Add to your Mendeley library History Published in print: Jun 1, 2011 Metrics Downloaded 55 times Topicsasha-topicsleader_do_tagleader-topicsasha-article-typesCopyright & Permissions© 2011 American Speech-Language-Hearing AssociationLoading ...

Few States Act on Parity Improvements This Year

Few States Act on Parity Improvements This Year

Estimation of a hedonic pricing model for Medigap insurance.

This paper uses a unique database to examine premiums paid by beneficiaries for Medigap supplemental coverage. Average premiums charged by insurers are reported, as well as premiums by enrollee age and gender, and additional policy characteristics. Marginal prices for Medigap benefits are estimated using hedonic price regressions. In addition, the paper considers how additional policy characteristics and geographic differences in the use and cost of medical care affect premiums. A comprehensive database on premiums paid by beneficiaries for newly issued Medigap policies in the year 2000 along with state-level characteristics. Hedonic pricing equations are used to estimate implicit prices for Medigap benefits. The Centers for Medicare & Medicaid Services contracted for the creation of a detailed database on Medigap premiums. Data were collected in three stages. First, letters were sent directly to insurers requesting premium data. Second, letters were directly to state insurance commissioner's offices requesting premium data. Last, each state insurance commissioner's office was visited to collect missing data. With the exceptions of the part B deductible and drug benefit, Medigap supplemental insurance is priced consistent with the actuarial value of benefits offered under the standardized plans. Premiums vary substantially based on rating method, whether the policy is guaranteed issue, Medigap Select, or explicitly for smokers. Premiums increase with enrollee age, but do not vary between men and women. The relationship between premiums and enrollee age varies across rating methods. Attained-age policies show the strongest relationship between age and premiums, while community-rated premiums, by definition, do not vary with age. Medigap supplemental insurance premiums are higher in states with poorer health, greater utilization, and greater managed care penetration. Despite the high cost, Medigap plans are generally priced in accordance with the actuarial value of benefits. The primary exception is the drug benefit, which appears to be subject to substantial adverse selection. Benefits such as the part B deductible and at-home recovery benefit offer little value to consumers. Several states require insurers to community rate premiums. Such regulation has important implications for premiums, and research needs to consider the impact of such regulation on the Medigap market.

One New Year’s Resolution to Keep: Advocate for Fair Reimbursement Through the STAR Network

You have accessThe ASHA LeaderASHA News1 Mar 2005One New Year’s Resolution to Keep: Advocate for Fair Reimbursement Through the STAR Network Cynthia Jacobsen and Maureen Thompson Cynthia Jacobsen Google Scholar More articles by this author and Maureen Thompson Google Scholar More articles by this author https://doi.org/10.1044/leader.AN1.10032005.2 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In For some of you, those personal New Year’s resolutions have already been forgotten. While goals to lose weight, quit smoking, or spend less may have fallen by the wayside, you can’t afford to forget about your professional resolutions because they can make a positive difference to a lot of people. What are your professional goals this year? Do you want to increase the visibility of your profession? Enhance reimbursement advocacy in your state? Enjoy enhanced professional recognition and satisfaction? If the answer is yes, lend a helping hand to ASHA’s State Advocates for Reimbursement (STAR) network. The STAR network is ASHA-member audiologists and speech-language pathologists who are willing to advocate locally with legislators, state insurance commissioners, health plans, unions, and employers on matters related to private health plan reimbursement. They share their advocacy skills and help create coverage and reimbursement strategies with state associations. They are the link between your state and ASHA. STAR members are a network in the true sense of the word-they are eager and willing to offer assistance, share information, and seek solutions to the reimbursement issues that challenge the financial viability of our professions. So what does STAR hope to achieve? Our mission is to advocate for consistent coverage and equitable reimbursement rates by private payers for speech-language pathology and audiology services. Forty-four states are represented in the network and STAR representatives must be able to count on you-our colleagues-to work with us to effect change in the private health plan system. We can’t do it alone. Regardless of where your private health plan concerns lie-with developing contracts, calculating appropriate fees, or obtaining “qualified provider” status, when you join forces with your STAR rep and other state association colleagues you will facilitate positive change. Teamwork is essential. Each of you knows how to communicate effectively. You are uniquely positioned to take on this challenge, improve reimbursement for our services, and work with your patients and families to ensure that, on a state level, decision-makers value the professions. You may ask, “How can I possibly make a difference?” To begin with, you can share stories of positive patient outcomes with legislators and decision makers or educate payers as to the cost effectiveness of speech, language, and hearing services. Your stories will demonstrate that speech, language, and hearing treatment leads to positive outcomes. You owe it to yourself, your patients, and your profession to make a long-lasting commitment. Meet with your STAR representative and select one issue to focus on-coverage of speech and language treatment for apraxia for example, or pediatric hearing aid coverage by a large employer in your state. The next step is gathering consumer education materials available from ASHA. Provide families with step-by-step instructions on contacting key decision-makers in your state. Meet with these key people on the state level and offer to be a resource regarding the needs of their constituents with communication disorders. If several of your patients contacted key decision makers in your state each week, administrators and legislators would pay close attention. After all, America’s historic civil rights movement began with a small nucleus of committed people. Their members set goals, developed plans, stayed flexible, and kept their eyes “on the prize.” In the beginning, goals were limited and grew with each success. While at times we may question the most effective methods for achieving comprehensive coverage of and reimbursement for our services; as we each work in our states to achieve change and share our successful strategies, we will find ways to achieve real and lasting results. Author Notes Cynthia Jacobsen, is the Kansas STAR representative and director of the Hearing and Speech Clinic, Children’s Mercy Hospitals and Clinics in Kansas City). Contact her at [email protected]. Maureen Thompson, is ASHA’s director of private health plan advocacy and coordinator of the STAR Network. Contact her at [email protected]. Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 10Issue 3March 2005 Get Permissions Add to your Mendeley library History Published in print: Mar 1, 2005 Metrics Downloaded 60 times Topicsasha-topicsleader_do_tagleader-topicsasha-article-typesCopyright & Permissions© 2005 American Speech-Language-Hearing AssociationLoading ...

Functional regulation in the 21st century

If complaints about an agent’s sale of “ABC” mutual fund are handled by the state securities commissioner… Why should complaints about the same agent’s sale of a variable annuity invested in “ABC” mutual fund be handled exclusively by the state insurance commissioner? Are state laws enacted 35 years ago still relevant today when most agents who sell variable annuities are also licensed to sell mutual funds?

Help Line Mediates Dispute Between Psychiatrist, Carveout

Help Line Mediates Dispute Between Psychiatrist, Carveout

Toward making 'IMEs' independent.

This article has no abstract.

The unavailability of information on insurance unavailability: Insurance redlining and the absence of geocoded disclosure data

The availability of insurance in urban communities has long been a contested public policy issue. One of the central points of contention has been the value of publicly available data on the geographic distribution of property insurance policies. This debate has intensified since the Home Mortgage Disclosure Act, which requires geocoded disclosure of mortgage lending activity, was passed. A small number of states have required disclosure of limited data. But precisely what data are available has been unclear, and their utility has been debated. This survey of all state insurance commissioners documents what is in fact the very limited availability of insurance disclosure data. Only eight states require any disclosure of geocoded data, and just four of them make company‐level data available to the public. Data from one of those states, Wisconsin, are used to show how such data could benefit insurers, consumers, and regulators.