GPAHU Pulse – June 2022

GPAHU - Monthly State and Legislative Updates

Here’s something to talk about when discussing plan design options and employer contribution strategy with group clients in the New Year.

About six in ten adults say they are currently taking at least one prescription drug and a quarter indicate they take four or more prescription medications. While about eight in ten adults (83%) say the cost of prescription drugs overall is unreasonable, most people say affording their personal prescriptions is easy (69%). However, certain groups are much more likely to report difficulty affording medication. These groups include those who take four or more prescription drugs, those with chronic conditions in their households, and those with an annual household income of less than $40,000.

Source : Hamel, Liz; Lopes, Lunna; Kirzinger, Ashley; Sparks, Grace; Kearney, Audrey; Stokes, Mellisha; and Brodie, Mollyann. “Public opinion on Prescription Drugs and Their Prices.” Kaiser Family Foundation, April 5, 2022.

The Big Three

Each month GPAHU identifies three top public policy or legal developments that could impact our members and clients.  Here are this month’s big three!

PA House Insurance Committee Considers Model Cybersecurity Legislation

Pennsylvania House Insurance Committee Chair, Tina Pickett (R-110), introduced legislation in April intended to protect Pennsylvania insurance consumers in the advent of a cybersecurity attack. The bill, known as H.B. 2499, is based on model legislation created and approved by the National Association of Insurance Commissioners in 2016. When the model was initially crafted by the NAIC, NAHU and all other major agent and broker associations expressed concern, since the requirements for agents and brokers who own or work for small businesses are fairly onerous. The House Insurance Committee held a hearing on the bill on June 8, 2022. PAHU is monitoring the issue and may submit testimony or a letter to legislators to explain these concerns.

CMS Issues Guidance About Agent Commissions and Individual Market Open Enrollment and Special Enrollment Periods

The federal Centers for Medicare and Medicaid Services (CMS) recently issued FAQ-style guidance concerning how health insurance carriers may pay commissions to agents and brokers who help individual market consumers during the annual open enrollment and special enrollment periods. The FAQs make it clear how valuable CMS feels agents and brokers are to individual market consumers. It also clarifies that if a health insurance carrier elects to pay commissions to agents during the regular open enrollment season, then they cannot vary or eliminate commissions for enrollments that occur during any special enrollment period. These practices would violate the guaranteed availability protections of the Affordable Care Act. NAHU was instrumental in getting this clarification through nation-level work with CMS officials. To read the FAQs, click here then page down to Health Insurance Market Reforms, FAQs, then June 7, 2022 “Frequently Asked Questions on Agent/Broker Compensation and Guaranteed Availability of Coverage.”

PA Insurance Commissioner Issues Reminder About Mental Health Parity Obligations

Pennsylvania’s Acting Insurance Commissioner, Michael Humphreys, recently issued a statement reminding the Commonwealth’s health insurance issuers and health insurance consumers about how serious the Department is about enforcing the provisions of the Mental Health Parity and Addiction Equity Act.  “The Wolf Administration has made consumer protection and rights a priority, and today, the department is emphasizing your right to receive coverage for mental health treatment under federal and Pennsylvania law,” said Acting Commissioner Humphreys. “Worrying about the cost of treatment should never be a deterrent to receiving the care you need, and that applies no less favorably to treatments for mental health and substance use disorders.”

In Pennsylvania, the Insurance Department is responsible for making sure that all fully insured coverage, Children’s Health Insurance Program (CHIP) and Medicaid is not more restrictive when it comes to mental health and substance use disorder coverage than for other medical and surgical coverage. To do this, the Department is actively engaged in reviewing the parity analyses state law requires each carrier to complete explaining how their products meet both state and federal parity standards. The Department also created an online guide for consumers to help them understand what their rights are and how the insurance department can help enforce them.  According to Commissioner Humphreys, the Department’s Consumer Services Division is standing ready to help any consumer who feels their health insurance does not cover mental health and/or substance use disorder services sufficiently.

Check This Out!

If you want to expand your health policy knowledge beyond this newsletter, here is a resource to check out!

The National Health Spending Explorer  provides up-to-date information on U.S. health spending by federal and local governments, private companies, and individuals. It was developed using data from the National Health Expenditure Account and is updated annually with each data release.

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