Around the PIA Western Alliance States – Week of January 6, 2025
Published January 7, 2025 at 1:45 PM · News Releases and Bulletins
Oregon — To all insurance companies writing auto insurance in Oregon: The Oregon Driver and Motor Vehicle Services division (DMV) requested that issuers of auto insurance policies be made aware of the following information. Additional details are available at OregonDMV.com.
What is changing?
Effective Jan. 1, 2025, a new law made changes to Oregon’s traffic laws that may impact your business. These updates include:
1. Expanded hit-and-run coverage.
2. Broader collision reporting requirements.
3. Updated terminology.
4. Renamed reporting form.
How does this impact auto insurance issuers?
These updates may affect how your clients report collisions and file claims. Educating them about the expanded requirements for hit-and-run and collision reporting may help avoid delays and possible suspension of driving privileges as a result of failing to submit a collision report to DMV.
Click here to review this memorandum:
Oregon — The Oregon Division of Financial Regulation recently announced the following permanent rulemaking: ID 41-2024: 2025 Gender-Affirming Treatment Rule
Adopted: 836-053-0441
Rule Summary: A carrier offering a health benefit plan may not deny or limit coverage under the plan, including, but not limited to denying or limiting coverage of a claim, issuing automatic denials of coverage or imposing additional cost sharing or other limitations or restrictions on coverage for gender-affirming treatment that is:
(a) Medically necessary, as determined by the physical or behavioral health care provider who prescribes the treatment; and
(b) Prescribed in accordance with accepted standards of care.
Filed: December 23, 2024
Effective: January 1, 2025
Oregon — ID 42-2024: Temporary rules to implement 2024 HB 4149
Rules Amended: OARs 836-200-0401, 836-200-0406, 836-200-0411, 836-200-0416, 836-200-0418, 836-200-0421, 836-200-0436, 836-200-0440
Need for Rules: 2024 Oregon House Bill 4149 made updates to the statutes regulating the conduct of pharmacy benefit managers (PBMs). Most significantly, it changed the existing requirement that PBMs register with the Oregon Department of Consumer and Business Services (DCBS) to a licensure requirement. There are extensive references to “registration” in DCBS’s existing rule that will need to be updated to “licensure” language. The law also expanded transparency requirements on PBMs, and new language is needed in the respective rule to reflect the addition of new data elements.
Filed: December 23, 2024
Effective: January 1, 2025 through June 29, 2025
Washington — New billing protections for ground ambulance patients take effect
Contact Public Affairs: 360-725-7055: Washington state’s Balance Billing Protection Act has been expanded to include protections for patients who have been transported by a ground ambulance. The new law bans balance billing or “surprise billing” for covered emergency and non-emergency ground ambulance transportation.
How it works
If you are transported by an out-of-network ground ambulance provider, they must bill your health plan directly. Your cost-sharing amount is limited to what it would be if the ambulance was in your health plan’s network and the ambulance provider cannot balance bill you or ask you to waive your balance billing protections.
The Office of Insurance Commissioner (OIC) convened a Ground Ambulance Advisory workgroup that sent a report and recommendations to the legislature in 2023.
In addition to the new patient protections, local government entities that have set rates for ground ambulance services must submit these rates to a public database each year.
Under the new law, the amount an insurer must pay an out-of-network ambulance provider is based on the rates set by local jurisdictions that operate their own or contract for ground ambulance services. If no rate has been set, the provider is paid the lesser of 325% of what Medicare would pay or the ambulance provider’s billed charge.
A public database was created so health insurers would know how much to pay out of network ambulance providers. The current payment formula used for paying them expires on Dec. 31, 2027. During the fall in 2026, the OIC will report to the legislature on reimbursement trends it has seen since the new law took effect. The legislature will use that information to determine if the formula needs to be updated.
Washington is one of an estimated 15 states with similar protections for ground ambulance patients. The federal No Surprises Act does not include ground ambulance protections, but a federal advisory committee was created to send recommendations to congress.
Washington — Kreidler’s office details options to improve insurance for carceral healthcare providers: Washington state Insurance Commissioner Mike Kreidler’s office submitted a report to the state Legislature on Thursday on liability insurance for community-based healthcare providers.
The report presents six policy options the Legislature could consider to improve the availability of health care malpractice coverage — and other liability protection options — for providers that deliver transition of care services to incarcerated individuals.
Background
Under Washington’s Medicaid Transformation Project 2.0, funds can be used to reimburse community healthcare providers (CHPs) for transitional services they provide to people during their last 90 days of incarceration. The state received federal approval for this amendment in 2023.
Medical and correctional leaders — who were interviewed as part of the report — strongly support this initiative, as people with an established relationship to CHPs before release from incarceration are more likely to continue treatment when re-entering their communities. This reduces recidivism, overdoses and other negative behaviors upon release and encourages compliance with medical or opioid use disorder treatment programs.
When CHPs started to consider this work, however, they found medical professional liability coverage either unaffordable or unattainable. Private insurers were reluctant to provide coverage in carceral settings, due to:
Legal entanglements of the Eighth Amendment and medical malpractice lawsuits.
Possible existing medical complications and a lack of continuity of care for incarcerated individuals. The location of care.
Reinsurance market restrictions.
The impacts on insurance companies’ financial ratings.
Policy options
Option 1: Expand data collected for the Office of the Insurance Commissioner’s confidential Annual Medical Professional Liability Study. Additional data could allow insurance companies to more accurately assess risk and provide coverage. This could also bolster future, broader carceral medical liability studies.
Option 2: Create a new risk pool (or other insurance mechanism) to provide medical liability insurance for transitional services. The state could subsidize the cost if the risk pool charges less than actuarially justified premiums for the coverage.
Option 3: Establish a joint underwriting association or similar mechanism to provide medical liability insurance for CHPs.
Option 4: Extend the state tort claims act to CHPs that meet certain criteria established by the state. The CHPs would be designated as employees of the state only when providing transitional services.
Option 5: Implement different negligence standards for transitional services provided by CHPs to reduce costs, so they can only be held liable if they display gross negligence or bad faith.
Option 6: Combine different policy options.
Kreidler’s office worked with Davies Actuarial and Alvarez & Marsal Financial Services on the report, which was prepared at the direction of the Legislature.
The Legislature convenes for its 2025 session on January 13, 2025.
Washington — Prior authorization modernization: We adopted the prior authorization rule (R 2024-03) on December 27, 2024. The rule takes effect on January 27, 2025. To implement E2SHB 1357, the Legislature’s 2023 prior authorization modernization bill, the Office of the Insurance Commissioner (OIC) proposed amendments to several Washington Administrative Code (WAC) provisions within Chapter 284-43 Subchapter D. The finalized rule updates prior authorization determination time frames for health care services and prescription drugs and clarifies health plan applicability standards.
For more information, including the adopted rule (CR-103) and the concise explanatory statement, please visit the prior authorization modernization (R 2024-03) webpage.