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- Insurance Regulatory Insights
Telos Actuarial brings you this week’s legislative and regulatory insurance insights from around the nation.
Bill “Status” is defined in the tables below by:
New: proposed law recently introduced for consideration by Legislature
Approved: passed by the Legislature and approved by the Governor
Movement: bill has progressed in legislative process
Fail: bill has died in committee or failed to pass
Medicare Advantage
State | Bill/Notice Number | Status | Summary |
|---|---|---|---|
All | New | Amends title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans (detailed summary below) |
This bill proposes for plan years starting Jan. 1, 2026, Medicare Advantage (MA) plans must meet transparency requirements by submitting reporting to the HHS Secretary annually, which would then be published on the public CMS website and reported to Congress.
For plan years starting Jan. 1, 2027, MA plans must establish an electronic prior authorization program, that provides for a secure electronic transmission of:
a prior authorization request from a service/supply provider to a MA plan; and
any supporting documentation relating to the request
Also, for plan years starting Jan 1, 2027, MA plans must meet the following enrollee protection standards:
adopting transparent prior authorization programs developed by consulting with enrollees, providers, and contracted suppliers;
allowing for wavier or modification of prior authorization requirements based on performance of providers and contracted suppliers demonstrating compliance with requirements; and
annual reviews of items and services with prior authorization requirements
The proposed bill also clarifies HHS authority to establish timeframes for electronic prior authorization requests, defines the term “applicable item or service” with respect to a MA plan as any item or service for which benefits are available under the plan (other than a covered Part D drug), and requires HHS and other agencies to report to Congress on program integrity efforts and other ways to further improve the electronic prior authorization process.
Dental
State | Bill/Notice Number | Status | Summary |
|---|---|---|---|
RI | Movement | Requires dental health insurance carriers to file an actuarial memorandum disclosing incurred claims/earned premiums by March 1, 2025 (reporting years 2023 & 2024) and March 1, 2026 (reporting year 2025), to assist with a study report/recommendations regarding a dental insurance loss ratio |
STLDI & Fixed Indemnity
State | Bill/Notice Number | Status | Summary |
|---|---|---|---|
PA | SERFF Notice (6/10/24) | New | STLDI and Fixed Indemnity forms used after the implementation effective date of the Federal Notice must be updated and submitted for review and approval. The new federal disclosure notice is to be embedded within the forms and be the leading or initial page, with the Company Name and Type of Insurance prominent and clearly identified on the page. A certification that the policy is compliant with the notice requirements should also be included in the filing. |
Telos Actuarial’s team of experienced regulatory compliance professionals are ready to help YOU stay informed of legislative and regulatory changes. Reach out to us for more information!