Mississippi Health Insurance Enforcement and Consumer Protections Grant Award

Cycle I Grant Application Summary

Mississippi: Mississippi Department of Insurance

Award Date: October 31, 2016

Total Award: $1,152,710.14

Baseline Award: $476,998

Selected Market Reforms Amount: $570,000

Workload Award Amount: $105,712.14

• Section 2707- The Mississippi Department of Insurance will enhance existing policy filing review processes to ensure health insurance issuers do not include discriminatory benefit designs that discourage people with potentially high-cost medical conditions from enrolling in those plans. As part of its plan to address issues of plan discrimination, the Department of Insurance will conduct a thorough review of the nondiscrimination standards and Federal legal requirements, and develop a comprehensive list of potentially discriminatory benefit designs. The Department of Insurance will conduct meetings with representatives of key State health insurance issuers to expand the identification of discriminatory benefit designs and establish procedures for reviewing policy forms in the individual and small group markets. The Department of Insurance will establish expanded non-discrimination guidelines for medical service plans and prescription drug formularies that will aid the Department’s actuaries with ongoing policy form review. The Department of Insurance will also evaluate the effectiveness of currently available policy review tools, and develop new and innovative tools to assist with and render the existing processes more efficient and user friendly. Additionally, the Department of Insurance will create and derive consultation from a “Clinical and Stakeholder Advisory Board.” The Department of Insurance will invite a number of stakeholders from across the State, including at a minimum, clinicians, health insurance experts, and citizens from various aspects of the individual and small group health insurance markets to participate on this Advisory Board to obtain first-hand observations and in-depth discussions related to the existing processes for forms submission. Input will also be solicited from Board members on questions regarding types of discriminatory design they might have encountered in the health insurance market and how best to identify and eliminate those.

• Section 2713 - The Mississippi Department of Insurance will enhance the review of health insurance issuer form filings to facilitate coverage of preventive health services without cost sharing. Mississippi will expand its policy form review procedures and, if necessary, develop and provide additional guidance to health insurance issuers in the form of bulletins and/or regulations that outline the requirements for full compliance. The Department of Insurance will implement changes to its existing processes to ensure that all health insurance issuers have access to the list of recommended preventive services specified in Section 2713, or that every policy form submitted specifies coverage for each required preventive service. The Department of Insurance will conduct State-wide training sessions for health insurance issuers regarding updated information and details of Federal and State requirements for preventive health services coverage and distribute any new guidance materials.

• Section 2718 - The Mississippi Department of Insurance will perform a feasibility study to determine whether implementing a Federal Medical Loss Ratio (MLR) audit and enforcement program at the State level, can and should be done. The Department of Insurance will assess the Federal review standards, and explore the possibility of HHS accepting the findings of the State’s audit of its issuers’ Federal MLR reporting and rebate obligations. The Mississippi Department of Insurance will develop a manual for future use in testing health insurance issuers’ compliance with all aspects of the MLR requirements and may perform analyses on issuers’ annual MLR reports, including comparing issuers’ reports against those of other issuers, both in Mississippi and in other States. This process will be aimed at identifying trends in the market and determining the appropriateness of each health insurance issuer’s reported items. The Department of Insurance will update its website to allow for annual reporting of final MLR examination reports, which will include detailed explanations of how the MLR calculations were tested, what the findings were, how compliant the various issuers were, and each issuers’ response to each finding, including any corrective action plans put into effect.

• Section 2726 - The Mississippi Department of Insurance will conduct a comprehensive review of health insurance issuer policy forms, summary plan descriptions, certificates of coverage, and other plan documents to assess all plans’ compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA). The Department of Insurance will establish a robust review of non-quantitative treatment limitations for medical/surgical and MH/SUD benefits to assure that the factors used in applying the limitation to MH/SUD benefits in the classification are comparable to, and applied no more stringently than those used in applying the limitation to medical/surgical benefits in the classification. The Department of Insurance will also consult with stakeholders across the State to determine whether a universal vocabulary can be adopted among health insurance issuers to make MHPAEA compliance easier to determine. Finally, the Department of Insurance will establish procedures and guidance for health insurance issuers regarding MHPAEA transparency and disclosure standards.