April 14, 2022 – This is your periodic update of state legislative and regulatory developments affecting companies involved in the self-insurance/captive insurance marketplace. Should you have any questions regarding the information provided in these reports, or would like to alert SIIA of new state legislative and regulatory activity (health care, workers’ compensation and/or captive insurance matters), please contact Anthony M. Murrello, Government Relations Coordinator, via e-mail at amurrello@siia.org.
State Legislative & Regulatory Update
Please find summaries of key state legislative and regulatory priorities below. For additional state legislation being tracked by SIIA, please access our new legislative tracker page here.
Louisiana
SB278 (Insulin Drug Coverage) – This proposed law would provide for a maximum patient cost sharing amount of $100 for a 30 day supply of covered prescription insulin, though it does not apply to insulin drugs administered intravenously. This bill allows health plans and PBMs to impose a cost sharing amount for less than the established maximum amount. If enacted, this proposal would take effect August 1, 2022.
HB677 (Insulin Drug Coverage)– This proposed bill would prohibit a health coverage plan from imposing a cost-sharing provision for insulin in the plan's formulary if the enrollee is required to pay more than $25 per prescription for a 30-day supply, regardless of the amount or type of insulin needed to fill the enrollee's prescription. This bill would also require a plan to include at least one insulin from each therapeutic class in the plan's formulary.
Minnesota
HF1774 (Single-Payer Proposal)– This bill seeks to establish a single-payer Minnesota Health Plan (MHP). The MHP would provide all Minnesotans health care coverage, including dental, vision, hearing, mental health, chemical dependency treatment, prescription drugs, medical equipment and supplies, long term care, and home care. It would allow patients to choose their providers and would allow the state to negotiate pricing on supplies, drugs and providers. Under this plan, premiums would be based on ability to pay and there would be an elimination of all co-pays. All Minnesota residents would be eligible for healthcare under the MHP, including those residents who are temporarily out of state. All payments under this plan would be disbursed from the Minnesota Health Fund, and be administered by the Minnesota Health Board. This bill would take effect the day following enactment. Bill was reintroduced 02/07/2022, currently in committee.
Nevada
This proposed regulation, which SIIA has testified upon and submitted formal comments, makes changes to the State’s stop-loss regulations, and amends certain date submissions. The proposed regulation raises the minimum specific attachment point from $10,000 up to $20,000, and the small employer group aggregate attachment point to the greater of 120% of expected claims or $20,000. The attachment point for non-small groups is at least 110% of expected claims. Other changes in this regulation include a prohibition on Lasering and direct payments to employees, members or participants. This proposal also effectively guarantees the rates of the policy for stop loss for at least 12 months, without adjustment (see bill text page 2 for exceptions). The proposal also states that any issuer issuing a policy for stop loss insurance must submit a form to the commissioner on or before April 1st of that year.
SIIA expects this regulation to be finalized by the NV DOI later this year.
New Jersey
A1743 (Small Group Stop-Loss) – This bill amends the N.J small employer health benefits (SHE) program, to prohibit health insurance carriers and other insurers from offering stop loss insurance policies to small employers in the state. Current N.J Law defines small employers with an employee average at least two but not more than 50 eligible employees, with the majority of those employed in New Jersey.
A2329 (Stop-Loss) – Requires 90 days’ notice of cancellation or nonrenewal of stop loss insurance for small employer health benefits plans. This act will take effect upon passage and will apply to stop loss or excess risk insurance policies issued or renewed in this State on or after the 90th day following enactment.
Virginia
HB884/S195 (MEWAs) – This bill would establish the ability of small businesses in the Commonwealth to create MEWAs for employee health benefits. The proposal requires any health benefit plan issued by a self-funded multiple employer welfare arrangement (MEWA) that covers one or more employees of one or more small employers to (a) provide essential health benefits and cost-sharing requirements; (b) offer a minimum level of coverage;(c) not limit or exclude coverage for an individual by imposing a preexisting condition exclusion on that individual; (d) be prohibited from establishing discriminatory rules based on health status related to eligibility or premium or contribution requirements as imposed on health carriers; (e) meet the renewability standards set forth for health insurance issuers;(f) establish base rates formed on an actuarially sound, modified community rating methodology that considers the pooling of all participant claims; and (g) utilize each employer member's specific risk profile to determine premiums.
This legislation has passed the House and Senate, and is being sent to the Governor for final approval.
HB481 (Hospital Price Transparency) – This bill would require hospitals to disclose information about standard charges for items and services more comprehensively.
State Policy Task Force
SIIA’s State Policy Task Force identifies, tracks and responds to relevant state legislative proposals and regulations as they are introduced. The Task Force is comprised of individuals from various backgrounds within our industry, who contribute their expertise towards state policy. We are always looking for engaged individuals to join the task force. If you are interested in participating, or would like more information, please contact Anthony M. Murrello at amurrello@siia.org.
