Relations Workgroup (GRW) and its subgroup on Network Adequacy monitor
legislative and regulatory proposals impacting the dental benefits
industry. The following are several recent updates from the groups’
- Annual privacy notices: A 2015 federal law on ‘Fixing America’s Surface Transportation’ (FAST Act)
reduces the need for financial institutions to provide annual privacy
disclosures to consumers. These disclosures apply to insurance products
and were first established as part of the Gramm-Leach-Bliley Act.
The GRW is monitoring state responses to the FAST Act. It appears that
states are required to issue a bulletin (or some other guidance) before
issuers can benefit from the FAST Act and the reduced disclosures.
Initial tracking and discussion show Arkansas, Rhode Island, Tennessee
and Idaho have already issued guidance on this topic.
- AR meeting regarding network adequacy process:
The Arkansas Insurance Department (DOI) held a meeting on Oct. 20 to
provide additional instruction and Q&A time for issuers submitting
provider data and network adequacy information. The slides and minutes
will be made available online here. A previous call on Sept. 27 noted regarding application that “these meetings do not apply to dental plans that are not in the Marketplace or not seeking certification.” Additionally, the submission deadline referenced in the Sept. 27 presentation has been extended to Nov. 4.
- CA notice of timely access law:
California Senate Bill 1135 became law last month and will add
notification requirements to the Health and Safety Code and the
Insurance Code. At initial enrollment and upon renewal, carriers must
provide information regarding appointment wait times for urgent care,
nonurgent primary care and nonurgent specialty care. The notice should
also include notice of the availability of interpreter services at the
time of appointment. The law requires the notice be included in
additional publications and on the Web. Issuers regulated by the
Department of Managed Health Care (DMHC) and the Department of Insurance
(DOI) as well as those participating in Medi-Cal may be impacted. Read
more in the bill text online here.
- ID DOI releases redlined network adequacy proposal: As noted in this month’s Soundbytes,
the Department of Insurance (DOI) held a meeting on September 30 to
continue discussions on draft network adequacy regulation. Very
recently, the DOI published a redlined version of the draft based on the September 30 meeting. The GRW network adequacy subgroup will review the draft in its next meeting.
- LA replacement policies regulation: As an update to this month’s Soundbytes
regarding proposed limited benefit policy replacement regulation in
Louisiana, the state’s Senate Insurance Committee has scheduled an
oversight hearing on Oct. 31. The meeting notice is available online here.
The proposal has seen strong opposition from industry and stakeholders,
including America’s Health Insurance Plans. The GRW is discussing the
measure and will monitor the hearing and any outcomes.
- MA Coordination of Benefits: The Massachusetts Division of Insurance recently released updated regulation on Coordination of Benefits
(COB), which the GRW is reviewing. Section 38.02 defines “Plan” to
include “8. Group and nongroup insurance contracts and subscriber
contracts that pay or reimburse for the cost of dental care.”