Around the PIA Western Alliance States

Idaho — Idahoans to see 12-percent lower health insurance costs with approval of key “Leading Idaho” waiver: Governor Brad Little announced the State of Idaho achieved a key milestone of the “Leading Idaho” plan – approval of the state’s innovation waiver, ensuring accessible health insurance for more Idahoans.

“Idahoans benefited from another win from our ‘Leading Idaho’ plan today. The approval of the state’s innovation waiver is estimated to reduce insurance premiums for individuals by about 12-percent, keeping more Idahoans insured and providing them better access to affordable healthcare,” Governor Little said.

The U.S Department of Health & Human Services and the U.S. Department of the Treasury approved this week Idaho’s application for a Section 1332 State Innovation waiver. The state submitted the Section 1332 waiver to increase affordability of individual health insurance in Idaho. This waiver approval is effective January 1, 2023, through December 31, 2027, and it is expected to reduce individual market health insurance premiums by 12-percent in the first year compared to premiums without the waiver.

The waiver will be implemented primarily by the Idaho Individual High Risk Reinsurance Pool, a state reinsurance program that helps reduce some of the insurance costs of certain serious medical conditions, thereby reducing the premiums charged to Idahoans. Governor Little recommended and the Legislature this year approved a one-time $25 million General Fund transfer to the Idaho High Risk Individual Pool Fund to lower health insurance premiums throughout the state. The pool was created in 2000. From its inception, it has successfully paid more than $164.6 million in claims from more than 13,000 Idahoans with serious medical conditions.

“The support of the Governor and the Legislature were critical to receiving federal approval of Idaho’s Reinsurance Pool innovation waiver,” Idaho Department of Insurance (DOI) Director Dean Cameron said. “Thanks to their support and our staff’s efforts developing a solid waiver application, Idahoans who purchase their own health insurance will have lower premiums going forward.”

As part of the waiver process, legislation signed by Governor Little this year, House Bill 611, authorized the DOI to submit the waiver application to the federal agencies and to condition the continuation of the state reinsurance program upon approval of the 1332 waiver.

DOI also received public comment during the application process.

The State of Idaho’s 1332 Waiver approval and fact sheet are posted online at https://go.cms.gov/3R7kDsr

Oregon — Proposed bulletin: E&O liability coverage for state licensed investment advisers: All Oregon-based professional liability insurance producers, the Oregon Division of Financial Regulation (DFR) wishes to publish a bulletin regarding errors and omissions liability coverage for state licensed investment advisers.

Purpose

The purpose of his bulletin provides guidance to Oregon-based professional liability insurance producers regarding errors and omissions insurance coverage required for state investment advisors under Oregon Revised Statute (ORS) 59.175(5). In order to meet the requirements, policies may not exclude investment advice or other management services performed by the investment advisor.

Public comments requested:

Public comment will be accepted for 30 days. Please submit public comment to DFR.Bulletin@dcbs.oregon.gov.

Last day for public comment: Friday, September 23, 2022, 5 p.m.

Click here to review proposed bulletin:

https://bit.ly/3Rh6loK

Washington — Cost-sharing for prescription drugs proposed rule posted: We have released the proposed rule language on R 2022-05. The rule Implements SSB 5610 (Chapter 228, Laws of 2022)—Prescription Drug Cost Sharing—Enrollee Contribution Calculation. The rulemaking will provide consistency and transparency to enrollees using third party payment assistance. The definitions of cost sharing and out-of-pocket maximum are clarified to include coupons and carriers are required to provide enrollees disclosure of their benefits and appeal rights when third party payments are used.

We scheduled a public hearing on the rule:

When: September 28, 2022 at 9:00 a.m.

Where: Register for the public hearing via Zoom.

Comments on the proposed rule language are due October 3, 2022; please send them to rulescoordinator@oic.wa.gov.

For more information, including the proposed rule language (CR-102), please visit the rule’s webpage.

Washington — General filing instructions for carrier submission of provider agreements and HCBM contracts proposed rule posted:

We have released the proposed rule language on R 2022-06. The rule will amend existing rules in order to establish unique general filing instructions for the submission of provider agreements and HCBM contracts by carriers.

We scheduled a public hearing on the rule:

When: October 5, 2022 at 10:00 a.m.

Where: Register for the public hearing via Zoom.

Comments on the proposed rule language are due October 6, 2022; please send them to rulescoordinator@oic.wa.gov.

For more information, including the proposed rule language (CR-102), please visit the rule’s webpage.

Washington — Statement Requirement for Consumer Adverse Benefit Determination Notices proposed rule posted:

We have released the proposed rule language on R 2022-04. The rule will amend existing rules so a required statement for consumer adverse benefit determination notices will be at a lower, more accessible reading level.

We scheduled a public hearing on the rule:

When: September 27, 2022 at 3:00 p.m.

Where: Register for the public hearing via Zoom.

Comments on the proposed rule language are due September 28, 2022; please send them to rulescoordinator@oic.wa.gov.

For more information, including the proposed rule language (CR-102), please visit the rule’s webpage.

Washington — Kreidler extends orders on coronavirus and surprise billing to September 25: Insurance Commissioner Mike Kreidler has extended three emergency orders. His order requiring health insurers to waive copays and deductibles for any consumer requiring testing for the coronavirus (COVID-19) and his order protecting consumers from receiving surprise bills for lab fees related to medically necessary diagnostic testing for COVID-19 are both extended until September 25.

Kreidler also extended his order requiring health insurers to cover coronavirus vaccine counseling until October 4.

Kreidler’s order waiving cost-sharing applies to all state-regulated health insurance plans and short-term, limited-duration medical plans. The order on surprise billing applies to both in-state and out-of-state laboratories when a provider orders diagnostic testing for COVID-19. Also, insurers must continue:

Allowing a one-time early refill for prescription drugs.

Suspending any prior authorization requirement for treatment or testing of COVID-19.