Regulatory Roundup: Mental Health Parity, Oklahoma Network Directories, Maine ‘Abandoned’ Applications

State-by-state variations of laws, compliance protocols, industry transparency, and general regulatory culture 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. 

Federal mental health parity rule under consideration 

The Internal Revenue Service (IRS), Employee Benefits Security Administration (EBSA), Department of Labor (DOL), Centers for Medicare and Medicaid Services (CMS), and Department of Health and Human Services (DHS) closed the comments in October on rules they proposed to improve mental health access in the U.S.

The rule would expand the current implementation of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). Michigan Department of Insurance and Financial Services (DIFS) Director Anita Fox joined that state’s governor in a news release praising the proposal.

“I am pleased to offer the Department’s support for these important rules and to make suggestions to further strengthen consumer protections to ensure that those who need these services have coverage on the same basis as other covered benefits such as cancer screenings and office visits,” said Fox.

If implemented, the new rules would go into effect Jan. 1, 2025 for group health insurance plans and Jan. 1, 2026, for individual plans. 

The proposals include:

• New restrictions on prior authorization requirements
• Standards for provider admission to insurance networks
• Methodologies for provider reimbursement rates
• Requirements for carriers to collect data on treatment outcomes
• Requirements for carriers to identify material differences between benefits

Health insurers required to maintain electronic network directories in Oklahoma

Health insurance carriers in Oklahoma must publish an electronic provider directory for each of their network plans, thanks to Senate Bill 442. The state published a bulletin to offer guidance to carriers, since the law is effective Nov. 1, 2023.

The new requirements state that a carrier must have a digital directory for each plan network, including the name, phone number, physical address, web address, and specialty of each health care professional. 

Carriers must update the directory every 60 days, make sure it’s accessible past physical ability or language barriers, and have a process for allowing people to report inaccuracies.

They also have to audit the information periodically, and report data accuracy to the state by March 1, 2025. 

Maine changing law for abandoned insurance producer applications

Have you ever worked on a project with multiple stakeholders where it became apparent that things that were high priorities for you were barely on the radar for others? 

Producer licensing applications can feel like that for state administrators when they have questions or delays with an application and the would-be producer responds to their inquiries with radio silence. Particularly with producers who have discrepancies or disclosures in their applications, regulators could be waiting on responses for days or weeks or… months… 

Maine has been feeling the pain with interminable applications. Thanks to a new law, would-be producers have 10 days to follow up with regulators concerning all questions. The state will primarily use email to contact people, who’ll then l have five days to respond to follow-ups.

Previously, the state’s “response to inquiries” law only applied to consumer complaints. For producer applications, the state’s administrative practice involved sending email requests over the span of several weeks, followed by mailed correspondence and an additional 30-day response period. Now, producers must follow up to state inquiries in 10 business days or the application will be considered abandoned. After that, the applicant will have to reapply and pay a new processing fee.

Other state regulatory changes

Alaska issued a bulletin to health insurers instructing them to suspend network requirements for pharmacies as shortages cause issues for consumers seeking immunization services, prescription drugs, and over-the-counter medication.

California laws clarified the conditions for resident and nonresident insurance agencies to use their organization’s license number in emails. Effective Jan. 1, 2024, producers and agencies alike will need to include license numbers for everyone involved in the email chain, with certain specific criteria.  

Colorado Division of Insurance officials joined Gov. Jarod Polis to announce their policies decreased the premiums that health insurance carriers in the state were requesting for 2024. Commissioner Michael Conway credited the Colorado Option and its requirement for inflation-adjusted premium reductions for lower premiums across many plans. The state also touted saving more than $20 million for consumers over the last fiscal year.

Delaware updated its captive regulations, including requirements for captives writing corporate “Side A” directors’ and officers’ coverage (D&O). The rules also “recalibrate” capital and surplus requirements. Delaware has touted its captive market and is a leader in the space. 

Missouri issued bulletin 23-04 clarifying the information a business must submit to the state if a cyber event breaches the security of any Missouri residents’ data, including a 10-day timeline for reporting.

North Carolina has updated its surplus lines premium tax due date: Tax and stamping fees are due within 30 days of the end of the quarter. 

Oklahoma announced its appointment renewals are live Nov. 23, 2023, to Jan. 2, 2024.

Oregon issued a bulletin to alert all producers to reasons the Division of Insurance will consider a license to be revoked or surrendered, like failure to provide or update accurate contact information or pending criminal litigation. (Did you know there’s a way to make sure this is done automatically? Let’s talk about AgentSync…)

Rhode Island issued bulletin 2023-5, clarifying what fees are allowed under state law, telling carriers, “It is the position of the Department that insurer operating expenses are required to be included as part of the filed rates and incorporated as part of the policy premium. Therefore, the Department does not allow the addition of fees to policies other than those charged for installments, late payments, or invalid or rejected payment methods.”

Tennessee announced the state has returned a state-record-breaking $13 million to consumers through state remediation and restitution.

Utah’s changes to the state’s suitability in annuity transaction laws will take effect Dec. 8, 2023.

Washington warned consumers about scammers during the Medicare open enrollment period. The state also announced it had reached a settlement with Sovereign Nations Insurance, which agreed not to sell or advertise policies in the state – if you’re curious, read the backstory.

Wisconsin Commissioner Nathan Houdek celebrated the state’s health insurance market competition ahead of open enrollment season, with residents in all 72 counties able to select from at least three carriers on HealthCare.gov thanks to the efforts of Houdek and Gov. Tony Evers.

While these points of interest aren’t comprehensive, our knowledge of insurance producer and variable lines broker 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.