States Make Strides on Commercial Insurance Legislation

While many of us have been actively monitoring the status of state Exchange legislation, state efforts to bring other state laws in line with the ACA have gone relatively unnoticed. We took a look at the resources posted to the State Refor(u)m milestone, “Enact legislation necessary to bring the state into compliance with federal law,” and found that many states have already passed commercial health insurance reforms. Many of these reforms were required to be in place by September 23, 2010, but some states have gone beyond the scope of the ACA’s requirements or have already passed commercial insurance reforms that are not required until a later date.
Below is a round up of some recent state commercial insurance legislation. This is not intended to be complete list of enacted legislation, but a reflection of states that have shared their progress with State Refor(u)m. This legislative language might help jump-start states working on similar legislation. We encourage you to share progress and post proposed and enacted state laws at State Refor(u)m. Choose your state, and the milestone “Enact legislation necessary to bring the state into compliance with federal law” under “Regulate the Commercial Health Insurance Market Effectively.”

• Colorado passed a law to require individual market carriers to offer child only policies during two open enrollment periods each year (SB 11-128).
• Connecticut introduced a bill that includes reforms required on September 23, 2010, such as the dependent coverage extension, no annual and lifetime limits, and limits on recissions, but also limits child-only policies’ ability to leave the market (RB 6323).
• California passed a law requiring insurers to file rate information prior to insurance rate changes (AB 1163).  The state also passed several complementary commercial insurance consumer protections to come into compliance with the September 23, 2010 deadline, including requiring health plans to offer coverage for dependents up to age 26 (SB 1088); prohibiting rescissions of health plans unless the plan can demonstrate fraud or intentional misrepresentation of a material fact and strengthening enrollee appeal rights (AB 2470); prohibiting denial of coverage to children with preexisting conditions (AB 2244); and ensuring that health plans provide certain preventive services with no cost-sharing (AB 2345).
• Maryland passed a package of commercial insurance legislation, including a medical loss ratio requirement; modifications to their appeals and grievances law; a dependent coverage law with a notice requirement at 60 days before the child becomes 26; and an internal appeals process that provides appeal rights when a plan determines that an individual is not eligible for coverage or rescinds coverage (SB 183).
• New York passed a law that requires prior approval of insurance rate changes and raises the minimum Medical Loss Ratio to 82 percent (S 8008).
• North Dakota passed a law that authorizes the insurance commissioner to administer and enforce provisions of the ACA and also requires that the commissioner provide updates to the legislature and submit proposed legislation for a special legislative session if needed (HB 1125). North Dakota also revised its grievances and appeals law to clarify its application to grandfathered health plans under the ACA (HB 1127).
• Vermont’s universal access and Exchange enabling law includes a rate review approval process that includes both the Commissioner of Insurance and the Green Mountain Care Board and requires that there be an electronic mechanism for the public to comment on proposed rate increases greater than five percent (Act 48).
• Washington passed a law that prohibits denial of services to children with preexisting conditions; limits deductibles and brings its grievances and appeals process into compliance with the ACA (SB 5122).

What has your state done to align its commercial insurance laws with the ACA? We encourage you to share progress and post proposed and enacted laws at State Refor(u)m. Choose yourstate, and the milestone “Enact legislation necessary to bring the state into compliance with federal law” under “Regulate the Commercial Health Insurance Market Effectively.”