(Helena, MT – Insurance News 360) – Those interested in how the first year of the Patient-Centered Medical Home Program (PCMH) went now have a place to find answers to their question. Recently, Montana Insurance Commissioner Monica J. Lindeen released a report related to the program’s first full year of operation.
The recently-released report from Montana’s Patient-Centered Medical Home Program (PCMH) will serve as a baseline for opportunities to improve healthcare.
The program was created in 2013 and is a team-based approach to primary care that emphasizes preventative care, coordinating care and outcomes-based data to determine where gaps in care persist.
Baseline data is encouraging in the one-year-old program, according to a report from the Montana State Auditor’s office.
“The baseline data is encouraging and supports the proposition that the PCMH program advances comprehensive primary care and will keep Montanans healthier. Evidence gathered from PCMH programs across the country demonstrates that in the long term, this program can reduce unnecessary emergency room visits and hospitalizations, especially for patients with chronic disease,” said Commissioner Lindeen. “PCMHs in Montana promote high-quality, cost-effective care by providing primary care providers with better opportunities and resources to enhance care coordination.”
The report includes data from PCMHs application, showing how they are improving patient care, baseline data compared to national estimates and federal Healthy People 2020 targets and rates of emergency room visits and hospitalizations.
“Previously, this kind of information about key health indicators in Montana was not gathered or shared with clinics so they could see where their efforts at disease control and prevention were working – or not working,” Lindeen said.
The public report is available at: http://csimt.gov/issues-reports/pcmh/pcmh-stakeholders/
Source: Office of the Montana State Auditor, Commissioner of Securities and Insurance.
(Tallahassee, FL – Insurance News 360) – In early January, the Florida Office of Insurance Regulation (FLOIR) announced that up to 71,500 personal residential and commercial residential policies may be removed from the Citizens Property Insurance Corporation. The two companies that will participate are Heritage Property & Casualty Insurance Company and Southern Oak Insurance Company. , Heritage Property & Casualty has approval to remove ? up to 55,000 personal residential policies and up to 1,500 commercial residential policies. Southern Oak Insurance Company got the okay to remove up to 15,000 personal residential policies.
The take-out periods are March 22, 2016 for personal residential impacting both the Personal Lines/Coastal Account policies and March 15, 2016 for commercial residential impacting both the Commercial Lines/Coastal Account policies. This is part of the state’s ongoing depopulation effort to reduce the number of policies in the state-created Citizens and transfer them to the private insurance market.
This announcement means that up to 277,149 policies have been approved for take-outs so far this year.
Policyholders who receive a take-out offer may choose to remain covered by Citizens through the opt-out process.
Source: Florida Office of Insurance Regulation.
(Raleigh, NC – Insurance News 360) – Two Fayetteville residents were arrested in late December on charges of insurance fraud and trying to get property under false pretenses in Lee County, in a case related to a January 2015 motor vehicle accident.
Brian Thomas Bright, 39, was arrested on Dec. 22, while Althea M. Smith was arrested on Dec. 23. Both Fayetteville residents were held on a $50,000 bond. North Carolina’s Department of Insurance investigators allege that Bright and Smith made false statements about a motor vehicle accident that ooccured on Jan. 16, 2015, in an attempt to commit fraud and obtain payment from Sentry Insurance.
Insurance Commissioner Wayne Goodwin announced the arrests on Jan. 6.
Source: North Carolina Department of Insurance.
(Louisiana, LA – Insurance News 360) – On May 4, Insurance Commissioner Jim Donelon made a reuet to the Federal Emergency Management Association to give Louisiana policyholders affected by the August 2016 flood more time to file their proof of loss statements. Typically, the deadline is 60 days after the incident. The requested extension would give them a year.
“I know that many of the affected policyholders are still actively engaged in the rebuilding process and in addition to contractor challenges have experienced a significant increase in the cost of labor and materials since last August,” wrote Commissioner Donelon in his letter to FEMA. “As a result, a great number of those affected policyholders will not be able to file the required Proof of Loss or Supplemental Proof of Loss by the looming May 12 deadline.”
Source: Louisiana Department of Insurance.
(New York, NY – Insurance News 360) – Governor Andrew M. Cuomo announced the initiatives to help New York residents with substance abuse issues in Long Island and New York City’s underserved communities. New regulations limit barriers to insurance coverage for addiction treatment and patient brokering.
Cuomo made these announcements on Sept. 6, at the opening of a new substance use disorder treatment center for women with children, female young adults and those over 55 years of age. The center is located on Wards Island.
“New York is committed to the fight against addiction, and with these latest investments, we are taking necessary steps to ensure individuals and families in underserved communities are connected with the resources and support services they need,” Governor Cuomo said. “These new regulations and expanded services are part of our continued efforts to support New Yorkers dealing with substance use disorders, as we work harder than ever to create a stronger, healthier New York for all.”
New Regulation and Guidance
A new DFS regulation requires insurers who offer large group coverage to allow consumers to appeal coverage denials for medically necessary addiction medications when they are not on the list of covered drugs. Insurers will be issued a checklist to ensure their compliance with new rules for reviewing the medical necessity of substance use disorder medications.
Additionally, OASAS will also take further action to restrict “patient brokering,” where brokers collect payments from treatment providers, in exchange for referring patients to those programs. A new directive will require this service be delivered by OASAS-certified and -credentialed professionals, who are prohibited from receiving referral fees.
Source: New York Department of Financial Services.
(Sacramento, CA – Insurance News 360) – Insurance Commissioner Dave Jones reached out to Sens. Lamar Alexander and Patty Murray to express concern over the instability in the individual health insurance market created by the uncertainty surrounding continuation of the Cost-Sharing Reduction payments (CSRs) provided for in the Affordable Care Act and actions taken by the Trump Administration such as reduced enforcement of the individual mandate.
In the letter to Alexander and Murray, who are members of the U.S. Senate Committee on Health, Education, Labor, and Pensions, Jones noted that about half of the California residents who receive Advance Premium Tax Credits through Covered California also rely upon CSRs to afford the health care covered by their health insurance policies.
Earlier this year, Jones authorized California health insurers to file dual rate submissions, one that reflects certainty in CSRs funding, and another that reflects the additional premium loads that will result from uncertainty regarding the funding.
Without the CSRs, Californians who get Silver plans may see rates that are 12.3 percent higher on average than if the CSRs called for in the ACA are funded.
“We have reached the eleventh hour when you must act to fund the CSRs or it will be too late to prevent double digit premium increases because the rates for 2018 must be finalized before the end of this month,” wrote Jones.
Source: California Department of Insurance.
(Lewisburg, PA – Insurance News 360) – In late August, Acting Insurance Commissioner Jessica Altman urged Congress to include provisions specifically supporting private market residential flood insurance in the reauthorization of the National Flood Insurance Program (NFIP), set to expire on September 30.
“The Wolf Administration has been educating homeowners, renters and condo owners concerning private market flood insurance options for the past year and a half, and has found in many cases that comparable private coverage is much more affordable than what is available through the NFIP,” Acting Commissioner Altman told a group of nearly 100 residents in Lewisburg, Union County. “I encourage consumers to visit our one-stop-shop flood insurance webpage, where we list insurers and agents selling private flood coverage in Pennsylvania. After that, it’s a good idea to make some calls to see if a better deal is available for them in the private market.”
In the first year that the Pennsylvania Insurance Department flood insurance webpage included private options, nearly 3,300 policies were issued, which is more than double from previous years.
The NFIP was created in 1968 to provide flood coverage for high-risk properties and included significant subsidies for these properties. Huge numbers of claims following Hurricane Katrina and Super Storm Sandy contributed to the NFIP falling $24 billion in debt, and Congress passing a series of laws that are phasing out the premium subsidies over time. The potential impact of Hurricane Harvey in Texas and Louisiana could make this problem even worse. As NFIP premiums rise to approach the cost of insuring the actual risk each property presents, the private market is entering the residential flood insurance market because it can now compete with the NFIP.
“Specifically, we need Congress to make private flood coverage that is comparable to the NFIP acceptable for federally backed mortgages. Lenders need to know this insurance is good coverage and they should accept it,” Acting Commissioner Altman said. “We also need Congress to require the NFIP to allow homeowners to switch to a private policy from an NFIP policy during the policy year, with no penalty, and receive a pro-rated refund of their NFIP premiums covering the remainder of the year. Bottom line, if a consumer finds a better deal they should not be penalized for taking it.”
Altman encouraged state residents to contact their U.S. congressional representative and senators and ask them to include private flood coverage in their NFIP reauthorization bill.
Source: Pennsylvania Insurance Department.
(New York, NY – Insurance News 360) – Financial Services Superintendent Maria T. Vullo Exercises Her Authority to Expand the Scope of an Independent Review and Issues Surrender Order Imposing Conditions for the Orderly Wind Down of Habib’s New York Branch
New Consent Order Follows a 2016 Examination Finding Continued Weaknesses in the Bank’s Risk Management and Compliance Following a Prior 2015 Consent Order
New York’s Department of Financial Services issued a $225 million fine against Habib Bank and its New York branch because the bank8 did not comply with New York laws and regulations designed to combat money laundering, terrorist financing, and other illicit financial transactions.
The investigation began in 2016 when DFS discovered that the bank’s risk management and compliance were weak and that they had not completed remedial actions required by a 2015 consent order.
Financial Services Superintendent Maria T. Vullo expanded an indep0endent review of the bank’s operations. As a fresul9t of the fine and the findings Habib Bank has agreed to surrender its license to operate the New York branch upon fulfillment of conditions outlined in a separate Surrender Order to ensure the orderly wind down of the New York branch.
“DFS will not tolerate inadequate risk and compliance functions that open the door to the financing of terrorist activities that pose a grave threat to the people of this State and the financial system as a whole,” said Superintendent Vullo. “The bank has repeatedly been given more than sufficient opportunity to correct its glaring deficiencies, yet it has failed to do so. DFS will not stand by and let Habib Bank sneak out of the United States without holding it accountable for putting the integrity of the financial services industry and the safety of our nation at risk. The terms of this Consent Order and the Surrender Order now agreed to by the bank will ensure that Habib’s misconduct will no longer occur on U.S. soil and that DFS will still investigate the bank’s prior activities.”
Source: New York Department of Financial Services.
(Concord, NH – Insurance News 360) – If the rate proposal to the New Hampshire Insurance Department for a 13.3 percent reduction of voluntary loss costs is approved.
This cost is the part of an insurance premium that pays for work-related injuries, and is wat insufrefrs use to set rates and premiums in the voluntary market. All insurers writing voluntary workers compensation in New Hampshire must use the new loss costs, along with a loading to cover company expenses.
The NCCI has filed a decrease of 10.3 percent for the assigned risk, or “residual,” market. The residual market ensures access to workers compensation for companies that can’t get coverage on the open market.
“A decrease in workers compensation rates means a decrease in costs to New Hampshire businesses.” said Insurance Department Commissioner Roger Sevigny. “These considerable savings could be used to bring more workers, higher salaries, and expanded operations to New Hampshire.
“The decrease in workers compensation rates is great news for job creators and seekers all across the Granite State,” said Governor Chris Sununu. “This will increase New Hampshire’s advantage with regards to attracting, retaining, and growing jobs.”
The NCCI is a licensed rating and statistical organization that gathers data, analyzes industry trends, and prepares workers compensation rate filings for New Hampshire and many other states.
Source: New Hampshire Insurance Department.
(Bismarck, N.D. – Insurance News 360) – On Dec. 21, 2017, Insurance Commissioner Jon Godfread announced that veterans who have taken any of the nine North Dakota insurance producer exams after June 1, 2017, may be reimbursed for their exam fee. This reimbursement comes from a partnership between the North Dakota Insurance Department and the Veterans Educational Assistance Program (VEAP), a program of the U.S. Department of Veterans Affairs (VA). Individuals wishing to sell insurance products in North Dakota must take the exam under their particular line of insurance to be licensed.
“I am grateful to the Veterans Educational Assistance Program for this opportunity and to the Department staff who pursued this partnership,” Godfread said. “This collaboration is just one way that we can express our gratitude to veterans for their service and help them to provide another great service to North Dakota consumers.”
Nine exams have been approved for reimbursement. They are:
Accident and Health
Crop Hail Insurance
Legal Expense Insurance
Life and Annuity
North Dakota resident producers who took state insurance exams between June 1 and Dec. 14 have been notified by email of their potential eligibility for reimbursement.
“I am proud of the collaboration between the Department and the Veterans Educational Assistance Program that will now allow us to offer this benefit to the men and women who have served this great country,” Zimmer said. “This is just one small token of our appreciation that we can offer to say thank you.”
For more information about exam reimbursement for veterans, visit www.nd.gov/ndins/producers/VeteranExamReimbursement or call the Department at (800) 247-0560.
Source: North Dakota Insurance Department.