Around the PIA Western Alliance States – Week of March 25, 2024

Montana — Supplemental Property Tax Bills: There was a dispute last year over Montana’s 95 mil school equalization property tax. County treasurers in 49 of the state’s 56 counties — in a dispute with Governor Greg Gianforte and the Montana Department of Revenue — reduced property taxes for hundreds of thousands of property owners.

The Montana Supreme Court upheld the governor and the Department of Revenue’s position and officials in those counties now have to send out supplemental property tax bills. Those payments will be due at the end of May.

The exact amount can’t be determined yet, but for a home valued at $450,000 will have to pay an extra $104.

For more information on the supplemental property tax bill, read the article from the Montana Free Press at the link below. It is packed with lots of information and a history of the dispute.

Source link: Montana Free Press — https://bit.ly/4apiEtn

Oregon — All issuers selling health benefit and pediatric dental plans: Based on the Center for Medicaid and Medicare Services’ (CMS) deadline for final plan data submission for 2025 plans, the Division of Financial Regulation (DFR) has prepared the following draft timeline for submission of 2025 form, rate, and binder filings. The filing deadlines apply to health benefit plans and exchange certified pediatric dental plans offered on-exchange and off-exchange. Dental products that will not be exchange certified are not required to follow this timeline.

DFR is providing these preliminary deadlines for planning purposes, but issuers are advised that we are still awaiting final federal due dates for 2025 plans. We will respond and adjust to changes in federal due dates as necessary.

2025-rate-filing-timelines.pdf​

Visit our Health Filing Requirements page for more information:

https://dfr.oregon.gov/rates-forms/health/Pages/health.aspx

This e-notify was distributed to the following groups:

● Rates & Forms New Developments

Oregon — One-time adjustment of student loans could lead to forgiveness: The U.S. Department of Education has begun what it describes as a one-time payment count adjustment for certain federal student loans toward the income-driven repayment and Public Service Loan Forgiveness (PSLF) programs. This could lead to borrowers potentially having their loans forgiven if they consolidate commercially owned Federal Family Education Loan (FFEL) or Perkins Loans into a federal Direct Loan by April 30, 2024.

The Oregon Division of Financial Regulation (DFR) issued a bulletin on this topic in February. The adjustment will apply to Direct Loans and government-owned FFEL borrowers who are working toward forgiveness via their payment plan, or PSLF. Covered loans that have been in repayment for at least 20 years (for undergraduate loans), or 25 years (for graduate loans) will be forgiven, and all covered loans will have their payment counts updated toward those goals. Although commercially owned FFELs and Perkins Loans are not themselves covered by the one-time adjustment, borrowers who consolidate such loans into federal Direct Loans by April 30, 2024, will receive the full benefits of the adjustment.

“We want to ensure that the current servicers are aware of the one-time account adjustment and pertinent deadlines,” said Lane Thompson, Oregon’s student loan ombuds. “Most borrowers will not need to take action in order to benefit from the one-time adjustment. However, some loan types are not owned by the Department of Education and need to be consolidated (FFEL, Perkins) in order to become eligible.”

Borrowers will need to visit the student loan consolidation webpage on studentaid.gov to consolidate into Direct Loans by April 30, 2024.

Anyone with questions or concerns can contact Thompson at dfr.bankingproducthelp@dcbs.oregon.gov or 971-374-3619.

Washington — NIPR Expands Licensing Services in Washington and New York: The National Insurance Producer Registry (NIPR) announced that it is now offering Resident and Nonresident Business Entity licensing and renewals for insurance producers, agents, and brokers in Washington and New York.

This expansion marks a significant milestone, as NIPR now provides licensing services for major lines in all 50 states and four U.S. territories.

“The collaboration between NIPR and both New York and Washington emphasizes our strong, trust-based relationships with regulators allowing us to better serve the insurance industry together,” said NIPR CEO Karen Stakem Hornig. “Insurance professionals can now fully leverage NIPR for business entity licensing and renewals in all states.”

These enhancements in services to the states are thanks to the hard work of our NIPR team members and their counterparts in Washington and New York, who continue to drive out complex, large-scale implementations. Their dedication to providing best-in-class licensing services allows us to fulfill the mission of our organization.

About NIPR

NIPR is a not-for-profit technology company with the goal of streamlining the producer licensing process. Governed by a Board of Directors representing state insurance regulators and members of the insurance industry, NIPR is an affiliate of the National Association of Insurance Commissioners. To learn more, visit NIPR.com.

Washington — Arbitration and using the Balance Billing data set: On February 1, 2023, the Office of the Insurance Commissioner (OIC) released a request for information (RFI) for the Balance Billing Protection Act (BBPA) dispute resolution mechanism (PDF, 267.35 KB). The OIC requested comments as to whether, under the authority provided in RCW 48.49.040, Washington state should transition to the federal No Surprises Act Independent Dispute Resolution (IDR) process on July 1, 2023 or continue to use the BBPA arbitration system to resolve disputes between carriers (or self-funded group health plans that have elected to participate in the BBPA) and nonparticipating providers.

After reviewing comments made to the first RFI on February 1, 2023, and going over recent litigation related to the No Surprises Act IDR process, the OIC will delay the transition to the NSA IDR process for a minimum of six months.

The OIC released a second RFI for the BBPA dispute resolution mechanism (PDF, 225.37 KB) on July 20, 2023. After reviewing comments made to the July 20, 2023 RFI and considering litigation related to the No Surprises Act IDR process, the OIC will once again delay the transition to the NSA IDR process for a minimum of six months, or no earlier than July 1, 2024.

The third RFI for the BBPA dispute resolution mechanism (PDF, 248.66 KB) was released on February 13, 2024, soliciting comments as to whether Washington state should transition to the federal NSA IDR system on July 1, 2024, or continue to use the BBPA arbitration system to resolve disputes between carriers (or self-funded group health plans that have elected to participate in the BBPA) and nonparticipating providers.

In response to comments received on the third RFI and pending federal litigation related to the federal NSA IDR process, the OIC will be delaying transition to the NSA IDR system for a minimum of 12 months or July 1, 2025.

What is the BBPA?

The Balance Billing Protection Act (BBPA) protects consumers from getting billed by a nonparticipating (also known as “out-of-network”) hospital or provider for emergency services and for nonemergency services performed by a nonparticipating provider at a participating (also known as “in-network”) hospital, including both inpatient and outpatient services, or ambulatory surgical center.

If a consumer is treated by a nonparticipating provider or facility for services covered by the BBPA, the provider or facility will submit the claim to the consumer’s insurer. They will be paid a “commercially reasonable amount” which is based on payments for the same or similar services in a similar geographic area. The insurer and facility or provider must first try to agree on this amount.

How arbitration works

If the insurer and provider or facility cannot agree on the amount for the service within 30 days, the dispute is settled through arbitration. Either party can start the arbitration process by sending a notice to the OIC. That notice must also be sent to the party that is not initiating the arbitration. For example, if a provider is initiating arbitration, the notice must be sent to the insurer.

Please visit OneHealthPort’s website for their health plan arbitration contact list (OneHealthPort.com).

The parties then choose an arbitrator from a list of approved arbitrators or entities providing arbitration services. If they cannot agree on one, the list will be narrowed to five. If the parties still cannot agree, one will be assigned from the narrowed list.

The arbitrator will determine the final payment amount the insurer or provider must accept by choosing one of the parties’ best final offer and then submit a decision reporting form and their decision to the OIC.  The arbitrator’s decision is final and binding on the insurer and provider.

BBPA arbitration forms and instructions

The BBPA rules include four forms that must be used for BBPA  arbitrations:

    Arbitration Initiation Request Form (Appendix A – WAC 284-43B-085)

    Arbitrator Decision Reporting Form (Appendix B – WAC 284-43B-090)

    Arbitrator Decision Reporting Form for Arbitration Proceedings under RCW 48.49.135 (Appendix C – WAC 284-43B-095)

    Settlement Reporting Form (Appendix D – WAC 284-43B-100)

Each form and instructions for its completion can be found in the links to the documents above.

Memorandum and presentations for arbitrators regarding E2SHB 1688 (chapter 263, laws of 2022)

This memorandum addresses provisions of E2SHB 1688 that relate to arbitration proceedings under the BBPA. These changes apply to arbitration initiation requests submitted to the OIC on or after March 31, 2022.

    Memorandum to arbitrators regarding E2SHB 1688 (Chapter 263, Laws of 2022) (PDF, 209.05 KB)

    Video presentation of E2SHB 1688 for arbitrators (www.vimeo.com)

    E2SHB 1688 Presentation for Arbitrators (PDF, 1.29 MB)

Surprise billing data set

The BBPA requires the OIC to prepare a data set through a contract with Onpoint Health Data.  The data set was created in consultation with a workgroup that included representatives of medical providers, hospitals, ambulatory surgical centers and insurers. It serves as a source of objective information for insurers, providers and arbitrators. The data set includes the following information, by geographic area, for services covered by the BBPA:

    The median in-network allowed amount;

    The median out-of-network allowed amount;

    The median billed charge.

The data set is based upon claims for services provided in calendar year 2018 and has been adjusted each year since 2019 by the Medical Consumer Price Index (CPI).

A data set from the state’s All Payer Claims Database that includes services subject to the BBPA is available for insurers, providers and arbitrators as an independent source of claims payment information.

    View the data set of Washington’s All Payer Claims Database (Excel, 4.28 MB)

    Watch a 2019 webinar (www.vimeo.com) on how to use the data set.

SEE ALSO

    Apply to be a balance billing arbitrator

    2021 Balance Billing Protection Act Annual Arbitration Report (PDF, 313.72 KB)

    2020 Balance Billing Protection Act Annual Arbitration Report (PDF, 313.76 KB)

NEED MORE HELP?

    Contact Policy and Legislative Affairs

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    Surprise billing and the Balance Billing Protection Act

        What consumers need to know about surprise or balance billing

        Medical providers responsibilities

        Ground ambulance services and surprise billing

        Health insurer responsibilities

        Self-funded group health plans and surprise billing

        Balance Billing Protection Act arbitration

            Arbitration and using the Balance Billing data set

            How to apply to be an arbitrator

            How to initiate Balance Billing Protection Act arbitration (Appendix A)

            How to report a Balance Billing Protection Act final decision (Appendix B and C)

            How to report a Balance Billing Protect Act settlement (Appendix D)

            Balance billing arbitrator application

            Contact the arbitration team

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Washington — Kreidler fines New York-based company $100,000 for operating illegally: Washington state Insurance Commissioner Mike Kreidler has fined First Premier Home Warranty Corp $100,000 and ordered the New York-based home warranty company to stop conducting insurance business in Washington.

The cease-and-desist order (fortress.wa.gov) — issued March 5, 2024 — noted that First Premier submitted a service contract provider application to the OIC in August of 2022, but never included the documents required to complete the process. Companies must be authorized by the Office of the Insurance Commissioner to transact or solicit insurance business in Washington state.

“We hold insurance companies and service contract providers to certain standards, both in how they gain approval to operate in our state and how they treat their customers,” Kreidler said. “Our laws and regulations are in place to hold accountable the companies that fail to operate within the law.”

A consumer with a home in Washington filed a complaint with Kreidler’s office after First Premier denied a claim for repairs to a refrigerator. Despite its service agreement stating it covered repair or replacement if any item became inoperable, First Premier denied the claim based on it being a “sealed system failure.”

The consumer requested a policy refund of $1,830 and was offered a $725.99 credit, after a $1,649 “administrative fee.” The consumer then filed a complaint with the OIC.

The company informed OIC investigators that it sold 22 service contracts, received $20,859.22 in payments and paid $5,549.83 to consumers.

Kreidler’s office oversees Washington’s insurance industry to ensure that individuals, companies, agents and brokers follow state laws. Since 2001, Kreidler has assessed more than $40 million in fines, which are directed to the state’s general fund to pay for state services. First Premier has 90 days from March 5 to request a hearing to contest the order.

About PIA Western Alliance

The Professional Insurance Agents Western Alliance is a membership organization promoting and enhancing the success of independent agencies seeking to grow, learn and be heard within the industry.


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