Maryland Overhauls Health Network Adequacy Guidelines, Rhode Island Takes a Look at DHS Adjuster Licenses

State by state variations of laws, compliance protocols, industry transparency, and general regulatory cultures can lend one the impression that keeping up with industry changes is a little bit like herding cats. So, what better way to wrangle some of the more localized insurance news than in a Regulatory Roundup?

On an ongoing basis, in no particular order or rank, we’re wrestling the various regulatory changes, compliance actions, and commissioner decisions into our roundup. As a disclaimer: There’s a lot going on at any given time in these here United States, so this isn’t a comprehensive picture of state-level action by any means. Think of it as, instead, a sampler platter of regulation. 

Also important to note: If we’re recapping interpretations of legal decisions, this is some armchair insurance speculation and not at all legal advice. If you need legal advice, get a lawyer. 

Maryland proposes an overhaul of health network adequacy guidelines for health insurance carriers

Maryland is closing the comment period on its proposed changes to the network adequacy chapter of Title 31 Maryland Insurance Administration. The proposal, published in the Maryland Register on Feb. 24, 2023, extensively changes data and documentation procedures for health insurance carriers in the state.

New standards will require carriers to map the “road travel distance” (aka driving distance) from all Maryland enrollees that use the carrier’s network of providers, mapping from everyone’s individual residences to their care provider for certain services. The state guidance includes a chart with various distances broken out by urban, suburban, and rural travel expectations.

For instance, while rheumatology services must be within 15 miles of an urban enrollee, 40 miles of a suburban enrollee, or 90 miles of a rural enrollee, OB/GYN services such as a certified nurse-midwife must be within 5 miles of urban enrollees, 10 miles of suburban enrollees, and 30 miles of rural enrollees.

Part of the updates are routine, acknowledging emergent areas of expertise like “addiction medicine,” which has been added to the maximum distance chart. Other updates include culturally significant trends. For instance, the proposal will require carriers to track the accommodations they make for different populations, like how many providers have environments that accommodate patients with physical or mental disabilities. 

Another case in point: Carriers must report how many primary care physicians in their network can speak American Sign Language, Spanish, Korean, Mandarin, Cantonese, Tagalog, and French.

The provision will also require carriers to demonstrate they “take reasonable steps to ensure services are delivered in a culturally competent manner” to communities who have limited English proficiency; varied cultural, racial, or ethnic values; or different genders, sexual orientations, and gender identities, from medical needs to claims processing. New reporting requirements mean carriers must track both their network providers’ specifics as well as their covered enrollees’ needs, and audit their data to show today’s reality and any attempts they’re making at progress in these areas. 

Telehealth also makes a sizable appearance in new reporting requirements. Carriers can get credit for covering telehealth visits in order to meet distance guidelines, but those credits are subject to specific limitations and caps. 

Rhode Island issues bulletin on DHS, claims adjuster licensing oddities

Rhode Island Insurance Commissioner Elizabeth Dwyer has issued a bulletin to provide clarity to independent and staff adjusters about the state’s requirements for a license class that’s even wonkier and more disjointed than regular producer licensing.

If you’re familiar with the genre, you’ll recall every state has a licensing process for insurance producers, which includes two real tracks of regulation: one that applies to its resident producers and one that applies to its nonresident producers. Adjuster licensing is similar, but with a catch: Many states don’t offer adjuster licenses. So, if you’re a resident of a state that doesn’t offer you a license but you’d like to work across multiple states in a reciprocal-license scenario, your path to a claims adjuster career starts with what’s called a designated home state (DHS) license.

Like a regulatory foster parent of sorts, a DHS license gives adjusters a regulatory home, a place to comply in order to get that reciprocal license and work across state lines in other states that offer this license class.

As we’ve covered before, relatively recent state changes have caused confusion for states that have DHS licensees. Rhode Island issued this particular bulletin to remind any adjusters who have been confused about licensing that:

• If their state now allows them to get any kind of adjuster license, even if they’re a staff adjuster or independent adjuster, they need to get the available license in their resident state, period.
• Reciprocity will be contingent on the adjuster having the appropriate adjuster license, no matter what state they have a DHS in.
• If your resident state change is really throwing you, and moving away from your DHS is going to be a massive headache, no worries. Rhode Island is giving everyone with valid DHS licenses the mantle of reciprocity through Dec. 31, 2028, so you have plenty of time to “get right.”

We also appreciate the opening of the commissioner’s bulletin for being forthright and earnest: “Rhode Island is in favor of uniformity, speed-to-market, increasing electronic efficiencies, and submitting valid data to the National Producer Database on behalf of our licensees.”

P.S. Remember that AgentSync can help make some of that adjuster tracking less onerous… See how!

Other state changes

Washington Office of the Insurance Commissioner officials have decided to delay adopting the federal No Surprises Act Independent Dispute Resolution process. According to a news release the state will continue to use the state-specific Balance Billing Protection Act for dispute resolution for the time being, although the OIC will update the industry by Sept. 1, 2023. The state has also revised procedures to prohibit carriers from backdating their appointments – no word yet on the impact that may have on existing Just-In-Time appointment regulations in the state.

Missouri has added a travel business entity license for resident and nonresident firms. Agencies and carriers can track this data through the National Insurance Producer Registry’s Producer Database or through AgentSync. As a reminder, the state requires business entities and insurance producers alike to maintain these licenses.

West Virginia issued a reminder of surplus lines individual and business entity license renewal periods. Surplus lines licenses renew on May 31 every year, which is an exception to other individual licensing rules in that state.

Florida issued a memorandum reminding industry players that, as of March 1, 2023, the parts of Senate Bill 2-A that push insurers to communicate quicker with consumers in coverage and claims matters are now in effect. If you’re thinking, “What else does that regulation effect?” then YOU’RE IN LUCK! AgentSync’s team pulled together a handy redux.

Alabama announced Heather Lowe to the Government Relations Manager position within the department. Additionally, as of March 13, 2023, the state has a new fingerprinting services vendor, Field Print.

New Jersey announced the state’s company appointment renewals, which carriers can view and pay from April 1 through June 5, 2023, on NIPR.com. (In the meantime, if you’re struggling to keep up with your appointment and termination obligations, check out how AgentSync could help!)

New Hampshire revised the state’s continuing education requirements, including expanding the state’s list of CE exemptions and clarifying that duplicative coursework won’t count for multiple credits. If you need a refresh on New Hampshire’s general regulations, check out the AgentSync Compliance Library.

Illinois, in adopting the Suitability in Annuity Transactions provisions to the Illinois Administrative Code has updated its CE requirements for producers selling annuities and clarified who the new guidance applies to.

Arkansas issued a reminder of carrier appointment and termination deadlines for producers. The state will post appointment renewal lists via NIPR from June 1 to June 30, 2023.

Michigan has adjusted its maximum limit for the pre-death assignment of insurance or annuity proceeds. Life insurers can now assign up to $12,720 from a life insurance or annuity contract to funeral or cemetery services. 

Kansas announced the Kansas Insurance Department will now accept livescan fingerprinting from 32 locations in the state in an effort to modernize and streamline the application process for insurance producers.

While these points of interest aren’t comprehensive, our knowledge of producer license and compliance maintenance is. See how AgentSync can help make you look smarter today; head over to the Compliance Library and wrastle up some state-by-state regulation and more jurisdictional updates.