COVID 19 Engaging Private Health Insurance for Coverage, Testing and Treatment
Table of Contents
- Why [Music] hello everyone and welcome to NC s l's...
- AHP what states cannot regulate our self-funded employee benefit plans where...
- It was going to come to Alaska it was just a matter of when and how could we...
- See how Alaska and does with reopening we also are requiring continued...
- So the Insurance Commissioner has actually Commissioner Kreisler has taken...
- And as Sabrina mentioned it was we are relatively unique in that the...
00:00
why
[Music]
hello everyone and welcome to NC s l's
webinar on co vid 19 engaging private
health insurance for coverage testing
and treatment my name is Samantha Scotty
and I will be moderating today's webinar
I am a senior policy specialist with M
CSL and I focus on issues relating to
healthcare access cost and coverage
today's webinar is a platform for
information exchange and engagement and
over the next 60 minutes we encourage
participation through our chat box so
00:34
feel free at any time to type your
question in the chat box which is in the
lower left hand of your screen to build
some comfortability with the chat
function and also to learn who is on the
line today I invite you to type in the
state from which you are joining us now
I also want to briefly mention the
resources tab on the website our
platform so above the presentation you
will see a couple of tabs with one of
them labeled resources here you can find
and download a PDF version of the
PowerPoint another tab is labeled
01:05
speaker where you can read the bio of
today's speakers on the line and you can
access these tabs at any time during the
presentation and today's webinar is
being recorded and will be available on
MC s l's website within the week Sam
for those of you not familiar with our
organization the National Conference of
State Legislators is the bipartisan
membership organization that serves the
state legislatures and legislative staff
of all the states Commonwealth's and
territories ncsl provides research
01:38
technical assistance and opportunities
for policymakers to exchange ideas on
the most pressing state issues and is an
effective and respected advocate for the
interests of the states in the American
federal system
before we jump in today's program I
wanted to briefly highlight a few covin
19 resources
available for you all from MCs l
NCSL developed a webpage to house our
comprehensive resources on the state and
federal response to cope in nineteen and
to view this information go to MC SL
02:12
website at ncsl org and from there
you'll see a banner on the top click it
and it will take you to the NPSL
coronavirus resources for states here
you can find information on state
policies and responses to continuity of
government health education disco
elections criminal justice and more
additionally today's webinar
today's webinar is the second in a
four-part series on kovin 19 and the US
healthcare system in this series we look
02:45
for how various aspects of the US
healthcare system including Medicaid
private health insurance health
workforce and healthcare facilities are
impacted by in responding to the Cova 19
pandemics and we'd like to thank the
Commonwealth Fund for their support of
this webinar series and encourage you
all to save the dates for the upcoming
two webinars and we will point you to
our website where a recording is
available for the previous webinar on
Medicaid
as the number of affirmed coronavirus
cases continues to rise across the
03:22
United States bolstering access to Coba
19 testing and treatment is an ongoing
concern so today we will discuss how
federal and state policymakers are
taking several steps to lower costs to
consumers and ensure adequate coverage
our first speaker Sabrina corlett
research professor and co-director of
the Center on health insurance reforms
at Georgetown University will provide an
overview of federal and state actions
expanding private insurance coverage
after we hear from Sabrina we will hear
two state perspectives first from Laurie
03:53
Ling hire director of insurance with the
Alaska Division of Insurance and Sarah
Bailey life and health supervisor also
with the Alaska Division of Insurance
and then we will hear from Jane Baier
senior health policy advisor with the
Washington State Office of the Insurance
Commissioner so with that I will pass it
over to Sabrina
thank you so much Sam it's really such a
pleasure to be with all of you today so
just real briefly as I mentioned I'm
with Georgetown University Center on
04:26
health insurance reform and we're a team
of about nine people that spend all day
and every day thinking about private
health insurance and thanks to a
generous grant from the Commonwealth
Fund we also have the privilege of
tracking action across all 50 states and
DC on what they're doing with respect to
private health insurance coverage and
this slide just has some ways to learn
more about what we do and to get in
04:56
touch with us either through our blog or
our tutor our Twitter account so first
I'm just going to share a few highlights
from how the federal government is
addressing private health insurance and
Co vid 19 services and it was mainly
done through two of the stimulus bills
the families first coronavirus response
act or thick rugs and the coronavirus
aid relief and Economic Security or
05:25
carers Act so in brief um just to
quickly kind of recap what the feds have
done is the law requires group health
plans and issuers including
grandfathered plans to cover and waive
cost-sharing for diagnostic testing for
kovat 19 plans and issuers must also
cover the items and services that are
delivered during a provider office visit
urgent care or ER visit that results in
05:57
an order for or an administration of a
bid nine tests these items and services
have to relate to determining the
individuals need for a test but if they
include influenza or other tests rule
out kovat 19 then they must be covered
and subsequent agency guidance has also
clarified that these newer antibody or
serological tests that are coming online
are also included
in this definition of testing it doesn't
06:30
matter whether the visit is in person or
via telehealth the carrier still has to
cover it and the law also prohibits
carriers from using prior authorization
restrictions or other medical management
techniques to restrict access to these
tests and then with respect to paying
for the lab tests the cares Act requires
plans and issuers to reimburse
laboratories either the negotiated rate
if one's been negotiated in advance or
the full cash price for the tests as
07:02
listed by the provider on a public
website also the provider relief fund
which folks may be familiar with it's
the 100 billion dollar or now one
hundred and seventy five billion dollar
fund to go to providers if a provider is
a recipient of those funds they have to
abstain from balance billing kovat 19
patients regardless of their sources
coverage so there are some continued
07:32
gaps and unanswered questions with
respect to the federal protections
there's there are first of all some
issues around who is covered so the law
says that for the coverage requirement
to kick in the tests must be ordered or
administered during the visit however we
know that due to capacity limits many
people are turning up with symptoms of
coded 19 but being turned away after an
initial screening because they don't
08:02
meet all the criteria or because tests
are not available so those folks
wouldn't necessarily get the coverage
protection also the coverage
requirements do not apply to short-term
plans healthcare sharon ministries or
excepted benefit products like fixed
indemnity products the Tri agency
guidance and try by tri-agency I mean
the Department of Health and Human
Services labor and Treasury the three of
those those three agencies are
responsible for implementing this law
08:34
they provided some clarifying guidance
they have said that plans and issuers
must
and pay for out-of-network testing
including testing done in
non-traditional settings like
drive-through testing sites however the
law does not explicitly prohibit balance
billing by out of network providers
unless as I mentioned the provider is
receiving funds from the cares Act
provider release fund so that brings us
09:06
to what states are doing and when it
burns the feds have largely been
following the state's lead but before I
get into the specifics of what states
are doing I do want to do just a quick
review and many of you are already
familiar with this but just in case to
sort of help set the stage for the ambit
of state regulation of private health
insurance in general states are the
first line of insurance coverage they
are responsible for regulating insurance
09:40
products and the business of insurance
so states can regulate individual market
coverage including mark ACA marketplace
coverage employer group plans if they're
fully insured and that just means the
insurance company is bearing the risk of
paying claims they can regulate short
term plans accepted benefit products
like fixed indemnity health care sharing
ministries and multiple employer will
fare arrangements or me was a form of
which is the Association health plans or
10:11
AHP what states cannot regulate our
self-funded employee benefit plans where
the employer is bearing the risk of
paying claims also for fully insured
products if the federal government has
set a standard the state may enact
stronger requirements so long as they
don't conflict with federal requirements
so a common example of this for example
is that you know the Affordable Care Act
prohibits health insurance companies
from using health status to set premium
10:42
rates and so that's a national standard
but if a state wanted to say that a
stricter standard like prohibiting
tobacco rating they could do that
okay well so let's talk about what the
states have done on kovat 19 as I said
the federal government has largely
followed the state's leads lead here
New York's Governor Andrew Cuomo was the
first out of the gate when he announced
emergency rules on March 2nd prohibit
prohibiting private insurance companies
from imposing cost-sharing on enrollees
11:13
when they visit a doctor's office urgent
care center or er to seek kovat 19
testing his announcement was closely
followed by directives in Washington
Alaska California Massachusetts and
several more indeed on the eve of
sakura's passage on March 18th over a
dozen states were requiring insurance
companies to cover testing without
costumes overall today we've seen 35
states and DC require insurance
companies to take some kovat related
11:44
action in addition to the mandates to
cover testing and several states have
also made recommendations that encourage
or urge insurers to take action but they
stopped short of a full legal
requirement and so I'll be talking about
both full legal requirements as well as
state action to encourage carriers to to
take certain actions so the first area
is koba 19 treatment and I don't know
folks have seen the exciting news that
12:15
the clinical trials of REM desapear to
treat Koba 19 are very promising so
fingers crossed we have on the potential
treatment coming online that's actually
successful and several large insurance
companies such as Aetna for example and
many of the Blues plans have pledged to
voluntarily cover Cove in 19 treatment
without cost-sharing however five states
and BC and you can see them here on this
map are requiring this coverage for all
12:48
carriers Idaho is here in light blue
because it is encouraging insurers to
waive cost-sharing for Cova 19 treatment
but it is not requiring it I should know
at Michigan and Minnesota here are in
dark blue but they are they have a
somewhat unique arrangement and that the
Department of Insurance on both states
brought
some insurance companies in and brokered
deals with them in which insurers agreed
to cover the cost of treatment another
big issue is early refills of
prescription medication and we've seen
13:20
20 states and DC require action on this
it's an important support for social
distancing and for those who have to
self quarantine an additional 12 states
have recommended that insurers provide
this coverage and essentially this
includes states that are requiring
insurers to cover early prescription
refills as well as states that are
requiring the length of the supply to be
extended typically from 30 days to 90
days
also in the area of prescription drugs
13:51
were seeing some action with respect to
off formulary access supply chain issues
as a result of coded nineteen can limit
access to certain drugs and so we've
seen seven states and DC require
insurers to expand access to off
formulary drugs when an on formulary
drug is not available in five states
that you can see on this map are
recommending that extension telemedicine
sell medicine is no longer just a nice
14:22
Bell and whistle enhancement to our
coverage it is frankly now essential we
have seen a lot of action here 23 faiths
and DC require expanded access to
telehealth and nine states are
recommending it these expansions are
taking several forms some states are
requiring parity and coverage some
parity and reimbursement with respect to
telemedicine versus an in-person visit
some are requiring parity and
cost-sharing or even a waiver entirely
of enrollee cost-sharing and some are
14:54
requiring carriers to expand the allowed
modes of telehealth so for example
requiring them to cover telehealth
visits over the phone some states are
also requiring carriers to loosen
certain barriers to telemedicine such as
requirements that a patient provider
relationship be pre-existing before the
telehealth visit
next slide is recognizing that hospital
staff are often stretched to the limit
in the current crisis ten states and DC
are directing insurers to limit the use
of prior authorization to work reduce
15:28
paperwork obligations and improve timely
access and thirteen states are making
this a recommendation some states are
prohibiting the prior authorization only
when it's directly connected to Kovac 19
services while others are more broadly
applied across all services another
critical issue is access to coverage for
the uninsured
although the Trump administration
announced that they would not open a
special enrollment period for the
federally run marketplaces of the 13
states that operate their own
15:59
marketplace 11 and DC 11 plus DC have
created a cove in 19 related step for
the special enrollment period for the
uninsured Idaho is the only state with
the state-based marketplace not to do so
10 states still have their special
enrollment periods in progress
Connecticut and Minnesota have ended the
District of Columbia just extended
theirs to September 15
um states are also taking action on
premium payment relief as many
16:31
individuals and small businesses are
struggling right now to make their
monthly premium payments 17 states and
DC are requiring insurers to take steps
to provide this relief 23 states have
made recommendations on the steps s the
that insurers are being asked to take
include providing premium brace periods
relaxing due dates wait and late fees or
refraining from coverage cancellations
notably New Jersey New York and
Washington are also requiring insurers
17:03
to take claims during all or part of the
grace period
so my last slide here is just looking
forward and how can we address continued
gaps in access and coverage and what's
the state role so first you know people
who are going to need help navigating
coverage transitions and some people may
actually experience multiple transitions
and coverage during the course of the
year such as from job-based coverage
Medicaid or if they start getting some
income from Medicaid to the marketplace
17:34
they get retired back to their employer
plan all of this is incredibly
complicated requires navigating very
arcane eligibility rules and a lot of
people are going to need one-on-one help
unfortunately the Trump administration
cut the ACA is navigator program by
ninety percent so there are fewer boots
on the ground than there used to be but
this is potentially an area where states
can step up and help second a lot more
people in spite of our best efforts are
18:05
going to be uninsured getting them into
the coverage it should be the priority
whether it's through Medicaid or
marketplace
SGP but States should also be working
with the federal government to ensure
that provider relief funds go as much as
possible to those safety net providers
serving the uninsured third states can
help fill in continued gaps in private
insurance coverage if we're ever going
to get people back to work in school we
will need widespread potentially even
18:35
universal testing yet we know from a
survey just out this week that lots of
people won't get a test due to the fear
of the cost so closing these loopholes
is really important
another issue is that unfortunately we
also know that not all tests out there
have been fda-approved and some are
frankly ineffective private insurers can
play a role to help providers and
consumers use only the high quality
tests that actually work also due to
capacity issues many consumers through
19:07
no fault of their own may be forced to
receive services from out of network
providers states can bar these providers
from balance billing patients for covert
related services for example New Mexico
has declared that all kovat 19 services
are subject to that state's balance
billing protections last but not least
we're still hearing that people are
facing upfront charges or other bills
for using telemedicine services it can
play a very helpful role here low end
barriers to this critical mode for
19:36
people to access providers thank you
I'll turn it over now to Lori
well thank you and again this is Laurie
wing hyerim the director of the division
in Alaska and with me on the line is
Sara Bailey many you have maybe met Sara
NAIC and other events she's the
supervisor of our life and health unit
and has been more than instrumental in
our response to Kovac Alaska when the co
of it and I don't want to say when it
became serious but when we realized that
20:12
it was going to come to Alaska it was
just a matter of when and how could we
protect consumers we were able to look
back a little on our history in 2018 and
pull from it we had a major earthquake
then and some of what we did we pulled
from lessons learned during the
earthquake and a couple of those things
were the early refills of prescriptions
and also the notices of cancellation as
Tobit 19 has progressed in Alaska and we
20:43
have done our we have had a mandated
hunker down as our governor and our
mayor's refer to it we have been very
fortunate in having slightly over 300
reported positive IDs as far as Kovac
testing and nine deaths however we found
some of our challenges as Alaska was our
size and that most of the medical
community is located in Anchorage
Fairbanks and Juneau with much smaller
hospitals that do not have ICU units in
21:16
rural Alaska so with that I'm going to
turn this over to Sara to start and I
will be cutting in and out as we talk
about what happened in Alaska and where
we're going and why we made the
decisions that we did when we made them
and Sara I'm going to turn it over to
you
Thank You Lori and thank you to ncsl for
holding than our as a glory mentioned
you know as as the outbreak of coded 19
21:50
uh was occurring in China we were
watching it closely and we knew that we
were concerned because while Alaska is
remote we are not isolated access to
health care has long been a challenge in
Alaska due to its size and its rural
population you have a population of
seven hundred thirty five thousand
people spread over five hundred seventy
thousand square miles many of our
residents reside in rural areas without
22:21
access to ventilators or other advanced
life support technologies in addition to
that the Anchorage International Airport
is the fifth busiest cargo Airport in
the world in terms of cargo throughput
and it's the second largest Norfolk in
North America in terms of landed cargo
leads roughly eighty percent of air
cargo traffic between Asia and North
America passes through Anchorage the
state also has significant regional
connections to Washington state with
22:52
many daily direct passenger flights into
the state Alaska has a transient
workforce in our major industries
including oil and gas mining fisheries
and tourism many of our workers come in
and out of the state and as they change
shift by weekly or monthly
also a significant portion of our
healthcare is access out of state
particularly those in the south east
23:23
area 22 to 25 percent of healthcare
might be received on a monthly basis in
this V at'll metro area so we were
watching what was happening in
Washington State very closely as well
now I just have a brief timeline January
28 the Anchorage International Airport
and the Alaska Department of Health and
Social Services provided support during
a layover of the first group of
Americans repatriated by the US
23:56
government from walk on all of the
passengers quarantined in California
from that flight and that group had no
resources of probit but it made us pay
very close attention and it it got us
going early on March 3rd the the
division had been monitoring the
movement of the virus as I said and we
issued our first bulletin following
cases of Koated nights in a Washington
State nursing home the bulletin
addressed preparations for stay at home
24:27
orders as the director mentioned such as
early refill on prescription drugs
handling and utilization review consumer
communication so that insurers were
telling their and their customers but to
expect and then contingency planning for
those insurance companies the initial
bulletin as the director mentioned also
reflected the state's response TV
November 18 at 7.00 Anchorage earthquake
25:00
March 11th governor Dunlavey declared a
state of emergency and on March 12 a lot
whispers confirmed cases for the night
and was announced and it was an
international cargo plane pilot in
Anchorage
during the time the division of
insurance during this time the division
of insurance work closely with other
state agencies and that was very key to
this we worked with our office of
professional licensing to implement
25:37
emergency telehealth provisions related
to the passage of House Bill 29 which
will I will speak to later in addition
we also coordinated this the Alaska
Health and Social Services both the
chief medical officer and the Medicaid
program personal is the state employee
health plan this coordination helped us
know the timing and the coverage of
coded 19 testing that we wanted to
require by private health insurance for
26:07
example initially we required no cost
sharing for testing of influenza RFP
respiratory panels and Koated nights
gained along with any offices then later
as I've noted in the slides when
recommended by our chief medical officer
the requirement for coverage of
respiratory panels would be eliminated
the goal behind this was make sure that
people were comfortable going and
getting a test
because at that time we had high rates
26:38
of our reinfection and we have high
rates of influenza infection and so we
really wanted to reassure people that if
they went in and got a test that that
they would be diagnosed with the correct
the correct moment
now in order to ease communication to
the public and for insurers and
providers the made efforts to harmonize
coverage requirement between private
payers Medicaid and the state employee
plans so that communication and
27:09
coordination to us was very important
I just want to speak a little bit to the
authority that the director of Insurance
has in Alaska under elective statute
21.0 6.08 0rs be she has emergency
Authority which allows her to take
action if the governor or president has
or is about to issue a disaster
declaration initially we were issuing
27:46
bulletins and recommending actions by
insurers after we issued those initial
bulletins and the director organized the
bulletins and we converted this
information into orders as the disaster
declarations occurred and I've attached
link for those orders
directors Authority is good for the
shorter of six months or the length of
the disaster this Authority can also be
renewed if necessary on March 28th the
28:19
Alaska Legislature passed Senate bill
241 which extended the governor is after
declaration until November 15
so you can see inside five six and seven
the orders issued by the director and
I'm just going to run through some of
these right now
for prescription drugs we call fractures
to cover early refills reduce prior
authorization requirements and provide
access at retail shops we wanted to make
sure that anyone who needed to get
28:53
access to drugs to get it before they
were asked to hunker down or quarantine
we were very concerned with maturer or
other high-risk Alaskan
we also have a requirement as I spoke
before to waive cost-sharing for
respiratory illnesses for the diagnostic
testing and associated office visits as
I said before we wanted to encourage
everyone to keep testing if appropriate
for their circumstances
29:26
we have suspended prior authorization or
utilization review requirements and are
expecting insurers to expedite claim
payments to reduce administration time
and to reduce the cost and burden on
health care providers providers who are
currently working very hard on kovat
related clinical changes
telehealth coverage we wanted to ensure
complete access and necessary health
29:59
care services despite the physical
distancing requirements that we were
under and we wanted to also we required
insurers to not apply onerous
restrictions on technology requirements
such as a proprietary technology
platform during this time Medicare also
liberalized their benefits and HIPAA
relaxed their enforcement and and so
30:30
what we saw was that the insurers
followed suit with with those things as
well
we also have prohibitions on the
termination of insurance plan student on
payment we are requiring insurers to
keep insurance contracts in effect even
if we will not pay timely this
requirement is in place until June 1st
we hope that that will give enough time
for employers to have a plan and and to
31:03
see how Alaska and does with reopening
we also are requiring continued
eligibility of coverage for employees
despite reduced hours or other changes
through employment status some employer
plans might require employees for 30 or
more hours in order to a week in order
to be eligible for coverage as some
businesses reduced hours or clothes
employees were at risk of being dropped
31:36
from coverage and
all happen so very quickly and and you
wanted to make sure that employees have
a choice and and the ability to make a
plan for themselves and for their family
I previously mentioned the Alaska
Legislature passed House bill 29 which
was a telehealth mandate for our private
insurance companies
eleska already had a benefit mandate
covering telehealth services for mental
32:14
health care and House bill 29 expansion
to help through all medical services
that can reasonably be provided by
telehealth of course there are some that
are not appropriate to be provided until
all have been in committee since the
legislature convene in January and even
before I believe in a black session as
concerns about the coronavirus increase
it was clear that telehealth is going to
be very important as as we're looking at
32:47
social distancing on this bill was
passed March 11th and it was signed by
the governor on March 16th and with
effective March 17 we worked with the
professional licensing division to
quickly implement procedures to register
health care providers and at the same
time as I said before medic cutter was
liberalizing telehealth service benefit
which became a very good template for
our private insurers
the Alaska law does not require purity
of payment between in person and tell
33:19
health visits however during the
disaster we are seeing insurers offering
this expanded benefit and that is
something that they are doing
voluntarily at this time
Alaska has a reinsurance program a
state-based reinsurance program is 2017
the Alaska Legislature passed
legislation to form the Alaska
reinsurance program which stabilizes
alaska's individual health insurance
market the program is primarily formed
excuse me funded through a federal 1338
33:55
innovation waiver
our program covered 33 listed conditions
and it's fairly unique I think there's
one other state that has a condition
based reinsurance program most states
that have reinsurance programs right now
they have a what I would call a
traditional reinsurance based model that
doesn't list condition so koban 19 as it
was coming in it it has the potential to
introduce new high-cost conditions into
34:26
our market and increase claim cost
leading to increase premium costs and
destabilizing our individual market so
on March 27th the division issued
emergency regulations adding cardio
respiratory failure and shock including
respiratory distress syndrome the Alaska
reinsurance program we had reviewed some
reports out of China a few some of the
very severe illnesses that that people
34:56
were experiencing there and this is the
condition that we had landed on to add
to our program funding for the addition
of a condition is available to Alaska
because we actually received more pass
through funding from the federal
government than we had initially
expected so we're able to fund this
through that that innovation waiver
as we work through the challenges of
35:28
probe 19 these are some of the changes
we found necessary to protect consumers
and our markets in Alaska
and we hope to be able to expand and and
do more as we as we see that there are
other things that needs to be done thank
you very much and I'll turn it back to
Samantha
thank you very much Sara and Lori for
that insight into Alaska's work and
before I pass it over to Jane I just
want to remind attendees that you can
36:06
submit a question at any time during the
event in the audience chat box and we
will also have some time at the end for
question and answer but I encourage you
to submit those now if you have
questions and with that I will pass it
over to Jane to hear about Washington's
office of the Insurance Commissioner's
response to cope at 19 great thanks so
much Samantha thanks an invitation to
present today so I'm going to talk a
little bit about Washington State's
36:36
response I think because Washington
State was the first state in the nation
with an outbreak we've learned a lot and
we have been more than happy to share
our experience with other states and as
Sara indicated the close relationship
between Alaska and Washington in so many
ways is a great example of that Sabrina
did a good job I think of talking about
the scope of Commissioner cry blurs
37:07
Authority and noting that we a States do
not have the authority to regulate
self-funded group health plans
overall the commissioner's authority
covers about 100 about 1.5 million
people who have coverage through this
fully insured market in Washington State
and this is I'm going to skip over this
this is just a pie chart that shows how
coverage is distributed in this state
and so given the fact that this is an
37:40
NCSL event I did want to take a minute
to talk about how critical it was that
during this period of time the
legislature had granted the Insurance
Commissioner in Washington state
authority to take actions when the
governor does declare an emergency and
in Washington state governor Inslee
issued his first emergency Proclamation
on February 29th and so essentially that
legislation authorizes the Commissioner
38:11
to modify reporting requirements for
claims to put in place or extend grace
periods and modify other duties of
people who have insurance to temporarily
postpone cancellations and non renewals
and with respect to health coverage most
importantly to take actions to ensure
access to care in Washington state it
sounds like the commissioner's authority
is somewhat shorter than that of the
38:42
alaska commissioners Authority the
initial duration of an emergency order
can be 60 days with a 30-day extension
and then of course as long as the
governor's emergency Proclamation is in
place if the Commissioner believes that
orders are still necessary
the Commissioner has the authority to
issue additional orders
but that authority is absolutely
critical when Sabrina was going through
the list of state and showing the states
39:15
that were able to require and the states
that were encouraging insurers to do
certain things I would not be surprised
at the critical distinction between
encourage and require was the
legislature having provided emergency
authority to the insurance regulators
and Sarah I think talked about and I
want to really really emphasize as well
that throughout this emergency close
coordination with the governor's office
with executive branch agencies and with
39:47
the legislature has been absolutely
essential we are the first to admit that
at the office of the Insurance
Commissioner we are not clinicians and
so we consulted frequently with
commissions at our State Department of
Health and with the Health Care
authority our State Health Care
authority purchases both for Medicaid
and for public employee coverage and
I'll talk a little bit later about
telemedicine payment parity but as
requests were flooding in from providers
40:20
and from consumers for the Commissioner
to take action to expand access to
telehealth services we were busily
researching what our statutory authority
was to issue emergency orders and we
found that given legislation that had
recently been enacted by the legislature
within literally the past month the
Commissioner didn't have statutory
authority to order telemedicine payment
parity we immediately reached out to the
governor's office and literally within
40:52
about 36 hours of our of Commissioner
Crider making the request that the
governor use his emergency authority to
issue an order he had issued an order
related to telemedicine payment parity
and then all throughout this process
we've tried to be as responsive as we
possibly could to questions from
legislators and legislative staff and
then also to work with legislators to
help explore policy options to address
the co19 pandemic
41:24
so the Insurance Commissioner has
actually Commissioner Kreisler has taken
a number of steps related to the Copa 19
emergency with respect to health
insurance he's issued three emergency
orders and two sets of what we call
frequently asked questions it is not
unusual at all and I'm thinking that
Alaska might have encountered this for
when the Insurance Commissioner issues
in order to have carriers and providers
41:55
and others submit well how should we
interpret this how should we interpret
that and so we've used this format of
frequently asked questions to be able to
elaborate on our interpretation of our
orders and then just really quickly with
respect to property and casualty
insurance
the commissioners issued one emergency
order he's issued guidance to ensures
reminding them of their legal
obligations when a claim is submitted
and also very importantly the Insurance
Commissioner did a market survey related
42:27
to business interruption insurance
coverage so given how big an issue
business interruption coverage is we
could have a sense of whether that
coverage is actually available in
Washington State and what the conditions
were around it and then we've just
recently adopted two sets of emergency
rules to try to help keep agents and
brokers in a position where they're able
to continue to stay in business so
talking more thematically about the
42:57
actions that we've taken with respect to
telemedicine I think similar to Alaska
in one of our emergency orders we
greatly broaden the methods to provide
telemedicine and one way in which we and
several other states departed from
Medicare was when medicated care did
their expansion of telehealth services
that expansion was pretty much limited
to modes of communication that have both
43:29
audio and video we the Commissioner made
a decision in his order to include
telephone and we did that for two
reasons number one for our behavioral
health providers so that where we had
individual providers who may not have
had access to some of the more
sophisticated communication methods they
could communicate the communicate via
telephone and we also were trying to be
really sensitive to the fact that some
of the folks who might have needed
44:01
services for example might have an
anxiety disorder or some other disorder
through which they were more comfortable
using a an audio-only or telephone means
to communicate with their provider
rather than sort of the higher tech
audio-visual modalities that are out
there and along with our doing this our
state Medicaid agency essentially was
doing the same put in the same policy
into effect and our Department of Health
44:31
issued emergency rules that relaxed some
of their requirements that required
face-to-face contact for behavioral
health services and again as Sarah
mentioned it was the office of civil
rights decision to back off or use their
enforcement discretion to allow non
HIPPA enabled means of telemedicine
services during the Kovach nineteen
public health emergency so all of those
45:02
things were absolutely critical in terms
of meeting demand and we have gotten
much feedback from providers thanking
the Commissioner and thanking the
Medicaid program and thanking the
governor for the payment parity
requirement and as I had mentioned
earlier the governor issue of payment
parity emergency order and so the order
not only says that the insurer must pay
the same amount that they would pay for
45:33
a face-to-face encounter but in addition
it says that if you have providers in
your network in your provider network
all of those providers need to be able
to use telemedicine services in order to
provide care
okay so with respect to prescription
drugs we did allow as Alaska did we did
order that commercial health plans
provide early refills during the Cova 19
46:06
emergency so that consumers could
maintain an adequate supply of
medication and about the same time the
Medicaid program issued an emergency
rule so again trying to be sending
consistent messages across healthcare
programs and an issue that did come up
was in the commissioners original
emergency order the Commissioner
prohibited carriers from applying prior
authorization requirements to code the
46:37
testing or treatment but when an
announcement I mentioned was made by the
White House and others about the
potential effectiveness of I think it's
chloroquine or chloroquine I'm not sure
how to pronounce it we had our carriers
get back to us and let us know there was
an immediate very big bump in
prescriptions and given how critical
these medications are to people with
conditions like lupus and rheumatoid
arthritis and having concerns about
47:09
those folks being able to access these
medications we did allow insurers to
place quantity prescribing limitations
if they had concerns regarding supply
and once again in terms of the
coordination just before we did that our
medical Commission which regulates
physicians had issued guidance to
physicians advising them to please be
careful about making prescribing
decisions related to these drugs so
another example of the coordination that
47:41
needed to happen
other issues that we addressed in our
very first order which was issued on
March 5th
we ordered we prohibited cost-sharing
and we required coverage pre deductible
for Cova 19 testing respiratory testing
and associated provider visit and as I
indicated we suspended prior
authorization requirements and we also
in Washington State fortunately have
48:11
very strong provider network access
rules and our rules already say that if
a price if an insurer doesn't have
capacity within their network they must
allow coverage or treatment by an
out-of-network provider and essentially
treat that out of network coverage as if
the consumer were receiving in-network
services and another issue that had come
up as well was our state healthcare
authority for the Medicaid program was
48:42
making massive efforts and are working
with our State Hospital Association in
giving concerns about folks that would
have to come into the hospital coma
diagnosis for coded treatment there was
a lot of focus that was being given to
being able to appropriately discharge
people who were ready for discharge from
hospital to home and so to try to
support that we said basically to the
insurers that they had to either hold
49:13
prior authorization requirement for
transfer from hospitals to long term
services and supports or at a minimum
expedite those requests
and we have all heard a lot about the
impacts of the order that the governor
issued reducing coverage of
non-emergency services and our state
legislature before it adjourn in
mid-march one of the final things that
49:47
it did was appropriate 200 million
dollars for a variety of purposes
including including supporting hospitals
with Kovac 19 Sabrina talked about the
the cares Act provisions the provider
relief fund the Medicare accelerated an
advance payment program although CMS
just announced yesterday I think on
Monday that they were suspending that
program given the hundred and
seventy-five million dollars that was
going out via the provider relief fund
50:20
and we do think there are some small
provider organizations that have sought
support through the Paycheck protection
program in the cares Act we've also had
carriers in Washington State and not
just in Washington state but nationally
announced efforts to process claims more
quickly United Healthcare announced that
nationally and one of our Blue Cross
plans announced a couple of weeks ago
setting up basically setting aside a
50:51
hundred million dollars to provide
advance payments to primary care and
behavioral health providers that could
then be recovered over the course of a
full year in 2021
you
we've all been watching what's happening
with health coverage enrollment impacts
with respect to individual and group
health plan the commissioner ordered a
minimum 60 day grace period requirement
51:24
and as Sabrina mentioned it was we are
relatively unique in that the
Commissioner has required that during
that 60 day grace period even if
premiums aren't being paid for claims
that are incurred during the first 30
days of that period the insurers do have
to pay those claims and then for claims
that are incurred during the second 30
51:54
day period the insurance company does
can it can in essence pen those claims
or hold them to see whether the employer
or individual comes current in their
payments and the other thing that we
have done is we have tried to
communicate very very clearly to
insurers that if they're working with
their employer groups and their
employers want to do something for
example in order to keep their employees
covered they want to allow employees
52:27
that are on unpaid leave to remain on
their plan or they want to reduce the
minimum number of hours that an employee
has to work in order to be able to be
eligible for coverage we are working as
hard as we can with insurers to try to
have them really really quickly modify
their plans so that they can keep folks
covered in terms of exchange in our
health benefits exchange Washington is
Sabrina indicated was one of the states
that set up a special enrollment period
for people who are currently uninsured
52:59
as of April 23rd about 6,000 people who
were previously uninsured had enrolled
in coverage and that that special
enrollment period lasts until May 8th
and then another 10,000 people have
enrolled using the sort of qualifying
event or
Enrollment Period that allows them to
come in when they lose their
employer-sponsored coverage and our
state Medicaid program is seeing about a
53:32
thousand new folks per day enroll in
coverage so that is what's going on in
Washington State thanks so much I'll
hand it back to Samantha
great Thank You Jane for that very
informative presentation and so now we
can take questions for Jane or other
presenters at this time and as we are
waiting for some questions to come in I
can kick it off I know that we've heard
interest from our members and concern
54:05
about how Associated Kovan 19 costs will
affect 2021 premiums also keeping in
mind that there's uncertainty around
fewer claims being processed due to
people accessing less care overall such
as elective surgeries and so can our
presenters comment on these concerns or
this uncertainty and maybe discuss how
potential ways insurers are mitigating
increased costs I could take that first
if you will this is Laurie wing hire
from Alaska we we have spent a lot of
54:37
time discussing this because I think
that when we suspended non elective
surgeries I think it was the right thing
to do but it shut down our providers for
quite a while and you know we were very
concerned I mean we saw layoffs in
certain communities W or in certain in
provider clinics and such facilities so
if you look at that you would think okay
if the claims aren't happening then when
kovat is it going to kind of be a wash
55:08
and in ours because we have been very
fortunate in the number of claims we're
not expecting kovat alone at this point
to be a really determining factor in any
rate increase or decrease as rates are
set the other thing is Sara talked about
is that we did put some money in our
reinsurance program so that the
individual market we hope will maintain
where it's at and not take an increase
because we're hoping that those claims
55:40
would go as a covered condition into the
reinsurance program and the insurers
wouldn't bear the cost the one thing
that I think we're concerned about and
we don't have answers to is that with
the number of unemployed that would
potentially lose coverage from their
employer
we've asked them to keep them on but I
think they can only keep them on for so
long that how many people from group
large or small will end up either in
56:11
Medicaid or in the individual market and
that is something we're struggling with
getting our hands around as as far as
how many what could we expect how many
are going to lose group health and their
option is going to be the individual
market and what is the health of that
population is it better than the
individual market is it worse and how
will it impact rates
and this is Jane I think I we second
56:46
what Laurie said except that we don't
have a reinsurance program here in
Washington State but I can say we have
had many discussions with insurers in
Washington State who have raised concern
with us as Laurie indicated we don't
know how many people might lose their
group coverage and come into the
individual market we don't know how we
know that claims have been going down
and that there has been a reduction in
57:17
claims as a result of delaying
non-elective services what we don't know
is when those services will pick back up
and of course all of that depends upon
what happens with the risk Ovid and with
the infection rates will those pick back
up in October or November of this year
or will people wait and delay those
services until 2021 whether because it's
been ordered or because they just feel
more comfortable waiting a while to come
57:49
back into the healthcare system
and Washington State does have I'm
trying to remember the exact number of
cases that we have but there is
unquestionably a Cova to impact in
Washington State we have made the
decision not to delay the filing date
for individual and small group health
plans to come in and that date is in
late May however we have traditionally
58:20
allowed insurers to adjust their rate
after the federal government lets
insurers know how much money they either
will be receiving or will be paying
under the ACA risk adjustment program
and so we are considering allowing the
cap the insurers to sort of give us a
coded adjustment later in the process
maybe in July so that they'll have a
couple of months more experience to be
able to look at their claims and what's
58:53
been happening
but again I will note that
the inch if an insurance company loses
money in 2020 their rates in 2021 are
not calculated to account for what
they've lost in the previous year their
rates are based upon what they think
their experience is going to be in 2021
and so we think what we might what we
59:22
might also see is insurers who say ok
I'm going to have to go into my surplus
or my reserves to help pay these extra
claims and so when I put together my
rates my requested rates for 2021 I need
to have some ability to sort of rebuild
those reserves and those surpluses so
those are just some of the things that
that come into play when we're having
discussions and reviewing great
59:56
thank you for that insight and I believe
we have time for one more question and I
will follow up after the webinar if you
are not able to get to your question and
it looks like this one is for Jane has
there been any discussion in Washington
about maintaining parity for telehealth
services after the disaster period
that's a great question
the legislature in the bill that they
passed in March required payment parity
beginning January 1 2021 and so we now
01:00:29
have payment parity in effect it will
hopefully be in effect as long as the
governor's emergency order is in effect
we don't know how long that's going to
be if there is a gap between the end of
the emergency order in January 1 2021 it
really will be up to the insurers to
sort of decide whether given that
they've done all their systems changes
to make that happen
they keep that payment parity in place
voluntarily until the mandate kicks in
on January 1 2021
01:01:04
right thank you so much and that is all
the time we have for today again I am
happy to follow up with you directly if
we did not get to your question but I
would like to thank everyone for their
participation in today's webinar and our
speakers for sharing their expertise and
insight and I would again like to thank
the Commonwealth Fund for their support
and finally I'd like to point our
attendees to the additional resources
shared on this slide including a
resource from the Commonwealth Fund and
some links to actions taken by private
01:01:34
insurers also at the conclusion of this
webinar a very short survey will pop up
on your screen and we'd really
appreciate you taking the time to
provide your feedback and this webinar
and other Kovan 19 resources for States
can be found on our website at NCSL org
thank you and have a wonderful rest of
your day
you