Oregon — The Oregon Division of Financial Regulation recently announced the following proposed rulemaking: Filing Caption: Amending OAR 836-150-0040 to add ORP payment parameters for plan year 2024
Amend Rule: 836-150-0040
Rule Summary: The current rule defines payment parameters for ORP for claims incurred during plan years 2018-2023. The amended rule will include payment parameters for plan year 2024 (attachment point of $95,000; reinsurance cap of $1,000,000; and coinsurance rate of 50%), while deleting the provisions related to plan years 2018 and 2019.
Filed: October 25, 2023
Hearing: November 16, 2023, 11:30 a.m.
This is a hybrid meeting conducted in-person and virtually via Microsoft Teams. See Notice of Proposed Rulemaking for Teams meeting instructions.
Last day/time to offer comment: November 22, 2023, 5 p.m.
For more information on this recently adopted rule, please visit the division’s website:
https://dfr.oregon.gov/laws-rules/Documents/Proposed/20231116-ORP-payment-parameters.pdf
Oregon — The Oregon Division of Financial Regulation recently announced the following proposed rulemaking: Filing Caption: List of Prosthetic and Orthotic Devices under Oregon SB 797 (2023)
Adopt Rule: 836-052-1000
Rule Summary: Establishes list of prosthetic and orthotic devices; prohibits internal or separate limits or caps on prosthetic and orthotic devices, other than the lifetime policy maximum, when permitted by law; defines when coverage for prosthetic and orthotic device is provided through a managed care organization.
Filed: October 26, 2023
Hearing: November 16, 2023, 10:30 a.m.
This is a hybrid meeting conducted in-person and virtually via Microsoft Teams. See Notice of Proposed Rulemaking for Teams meeting instructions.
Last day/time to offer comment: November 22, 2023, 5 p.m.
For more information on this recently adopted rule, please visit the division’s website:
https://dfr.oregon.gov/laws-rules/Documents/Proposed/20231116-Prosthetic-Orthotic-Devices.pdf
Oregon — All entities offering health benefit plans in Oregon: The Oregon Division of Financial Regulation (DFR) proposes to issue the attached bulletin regarding expectations for health benefit plans under the Oregon Reproductive Health Equity Act (RHEA).
Purpose
The purpose of this bulletin is to provide guidance on the director’s expectations for health benefit plans with respect to RHEA. Topics addressed in the proposed bulletin include:
The scope of services that must be covered under RHEA;
RHEA’s prohibition on cost sharing;
Reasonable medical management under RHEA for services other than contraception and abortion;
Coverage of contraception under RHEA, including therapeutic equivalents and examples of impermissible restrictions;
Coverage of abortion under RHEA.
Public comments requested:
Public comment will be accepted for 4 weeks. Please submit public comment to
Last day for public comment: Monday, December 4, 2023. Comments must be received by 11:59 p.m.
Click here to review proposed bulletin:
https://dfr.oregon.gov/laws-rules/Documents/Bulletins/proposed/RHEA-health-benefits-expectations.pdf
Oregon — The Oregon Division of Financial Regulation recently announced the following proposed rulemaking: Filing Caption: Amending OAR 836-150-0040 to add ORP payment parameters for plan year 2024
Amend Rule: 836-150-0040
Rule Summary: The current rule defines payment parameters for ORP for claims incurred during plan years 2018-2023. The amended rule will include payment parameters for plan year 2024 (attachment point of $95,000; reinsurance cap of $1,000,000; and coinsurance rate of 50%), while deleting the provisions related to plan years 2018 and 2019.
Filed: October 25, 2023
Hearing: November 16, 2023, 11:30 a.m.
This is a hybrid meeting conducted in-person and virtually via Microsoft Teams. See Notice of Proposed Rulemaking for Teams meeting instructions.
Last day/time to offer comment: November 22, 2023, 5 p.m.
For more information on this recently adopted rule, please visit the division’s website:
https://dfr.oregon.gov/laws-rules/Documents/Proposed/20231116-ORP-payment-parameters.pdf
Oregon — The Oregon Division of Financial Regulation recently announced the following proposed rulemaking: Filing Caption: Primary Care Provider Assignment (SB 1529)
Adopt Rule: 836-053-0028
Rule Summary: Insurers must assign enrollees who are residents of the state of Oregon to an individual or group of individuals who are “primary care providers” in a specified hierarchal order.
Filed: October 26, 2023
Hearing: November 16, 2023, 2:30 p.m.
This is a hybrid meeting conducted in-person and virtually via Microsoft Teams. See Notice of Proposed Rulemaking for Teams meeting instructions.
Last day/time to offer comment: November 22, 2023, 5 p.m.
For more information on this recently adopted rule, please visit the division’s website:
https://dfr.oregon.gov/laws-rules/Documents/Proposed/20231116-PCP-assignment.pdf
Oregon — The Oregon Division of Financial Regulation recently announced the following proposed rulemaking: Filing Caption: Adoption of rule to allow for copayment on primary care visits
Adopt Rule: 836-053-0027
Rule Summary: Allow for copayment on primary care visits.
Filed: October 25, 2023
Hearing: November 16, 2023, 1:30 p.m.
This is a hybrid meeting conducted in-person and virtually via Microsoft Teams. See Notice of Proposed Rulemaking for Teams meeting instructions.
Last day/time to offer comment: November 22, 2023, 5 p.m.
For more information on this recently adopted rule, please visit the division’s website:
https://dfr.oregon.gov/laws-rules/Documents/Proposed/20231116-primary-care-copayment.pdf
Oregon — The Oregon Division of Financial Regulation recently announced the following proposed rulemaking: Filing Caption: Alternative Documentation of Loss Under HB 2982 (2023)
Adopt Rule: 836-080-0245
Rule Summary: Compliance with ORS 742.053 and reference to the DFR website for a model form used to attest the
total loss of contents of a residence after a major disaster.
Filed: October 26, 2023
Hearing: November 15, 2023, 9:30 a.m.
This is a hybrid meeting conducted in-person and virtually via Microsoft Teams. See Notice of Proposed Rulemaking for Teams meeting instructions.
Last day/time to offer comment: November 22, 2023, 5 p.m.
Oregon — 440-3610 Standards for Personal Lines Liability and Commercial Lines Liability Forms, Rates, and Rules
New items added please check out
Rates and Forms: Updated Product Standards
Washington — Sovereign Nations Insurance agrees to stop selling unauthorized insurance in Washington: Sovereign Nations Insurance, LLC, has signed a settlement agreement with Insurance Commissioner Mike Kreidler and has agreed to cease its operations in Washington state.
Kreidler ordered Sovereign Nations to stop selling unauthorized insurance products in Washington last year, issuing a cease-and-desist order on December 20. The company requested a hearing in response.
Per the settlement agreement, signed on November 1, the company will end all insurance business in Washington and not re-enter the state insurance market. In return, Kreidler’s office will not fine the company for selling insurance without authorization from the OIC.
The company is based in Utah and describes itself as a tribally owned and controlled domestic health insurance company, regulated by the three tribes that created it. The company sold eight insurance policies to Washington consumers without being authorized to do so. The health plans it sold also contained pre-existing condition exclusions and waiting periods, which are illegal in Washington (RCW 48.43.012).
The federal McCarran-Ferguson Act guarantees states regulatory authority over insurance.
“These products didn’t meet the standards we’ve established to protect consumers in Washington,” said Kreidler. “This settlement is good outcome for everyone. I’m also very grateful for the consultations we had with tribal representatives across the state. Their assistance was invaluable.”
Washington State has a strong history of working with tribes on health care issues. Kreidler invited Washington’s tribal leadership for a consultation last November to discuss the company operating as a sovereign tribal insurer in Washington.
Washington — Essential Health Benefit (EHB) public meeting series: Health Management Associates’ Wakely Consulting Group is the actuarial firm assisting OIC with the EHB update project. We have scheduled a public meeting on December 13, 2023 from 9-10:00am PST. At the meeting, the Wakely team will review their draft EHB update report.
The meeting will be virtual. Please register for the meeting — https://bit.ly/47pcM0X
