Joins ten Insurance Commissioners in providing short- and long-term recommendations to the incoming administration

A group of the nation’s state insurance commissioners joined together in a pledge to work with President-elect Joe Biden by providing health policy recommendations to the incoming administration.

The commissioners share President-elect Biden’s vision that no American should have to go without health care coverage. They believe comprehensive and progressive health care is essential to addressing urgent public health priorities, such as the COVID-19 and opioid crises, addressing racial disparities in the health care system, and ensuring enforcement of mental health parity.

“President-elect Biden knows the healthcare needs of Delaware residents first-hand. So many of the healthcare challenges we face are being felt across the country, and I am proud to join Insurance Commissioners from coast to coast in recommending short and long-term policy solutions,” said Delaware Insurance Commissioner Trinidad Navarro.

A letter sent by the group of commissioners detailed six immediate or critical policy recommendations and six longer-term recommendations for the Biden administration to consider.

Immediate policy recommendations

• Ensure immediate access to the federal marketplace, Healthcare.gov, through a special enrollment period.
• Provide immediate relief from Affordable Care Act (ACA) subsidy clawbacks created by COVID-19 uncertainty.
• Provide clarity on COVID-19 testing coverage requirements, especially in regard to tests that are ordered as part of state-based contact tracing efforts.
• Partner with states in actively focusing on programs and practices that address the needs of historically marginalized communities.
• Address problematic elements of the recently proposed Notice of Benefit and Payment Parameters (NBPP) for Plan Year 2022.
• Allow flexibility for states aiming to pursue progressive policy aims by empowering them to apply for ACA innovation waivers beyond reinsurance.

Longer-term policy priorities

• Reverse policies, such as the weakening of non-discrimination protections and the public charge rule, that undermine the ACA and deny health care coverage to many people.
• Encourage both people and small businesses to enroll in ACA programs, and stop encouraging enrollment in insurance plans that do not provide the ACA’s most critical consumer protections.
• Improve income counting rules to allow consumers greater flexibility.
• Extend premium tax credits to Deferred Action for Childhood Arrivals (DACA) recipients so that legally present noncitizens have access to health care coverage.
• Modernize Department of Labor oversight of the Employee Retirement Income Security Act to ensure all health insurance coverage is held to similar standards.
• Consider a national reinsurance program to stabilize health insurance markets and improve affordability of health insurance coverage.

Enacting these policy recommendations will provide immediate relief to many Americans affected by the COVID-19 crisis, provide states with flexibility to strengthen health insurance markets, remove discriminatory barriers to health coverage, protect the coverage needs of Americans with pre-existing conditions, and ensure comprehensive health insurance access is available to all Americans.

The following state insurance commissioners developed these recommendations and are committed to working with the Biden administration on its national health care plan:
Commissioner Ricardo Lara, California
Commissioner Michael Conway, Colorado
Commissioner Trinidad Navarro, Delaware
Commissioner Colin M. Hayashida, Hawaii
Director Anita G. Fox, Michigan
Temporary Commissioner Grace Arnold, Minnesota
Commissioner Andrew R. Stolfi, Oregon
Commissioner Jessica K. Altman, Pennsylvania
Health Insurance Commissioner Marie Ganim, Rhode Island
Commissioner Mike Kreidler, Washington
Commissioner Mark Afable, Wisconsin

View the Commissioners’ Letter

Provisional Affordability Standards aim to strengthen primary care in Delaware through increased investment

Insurance Commissioner Trinidad Navarro announced the release of the Office of Value-Based Health Care Delivery’s initial provisional Affordability Standards as part of a new report, Delaware Health Care Affordability Standards: An Integrated Approach to Improve Access, Quality and Value, which includes plans to more than double primary care spending in the commercial fully-insured market by 2025.

The Affordability Standards announced today also include decreasing price growth for certain healthcare services and expanding the use of payment models that aim to improve healthcare value. The Affordability Standards and targets were informed by data from Delaware health insurers, the Delaware Health Information Network Health Care Claims Database, publicly available sources, and the perspectives shared during more than two dozen stakeholder interviews.

“An effective healthcare environment requires a strong primary care system, but it also requires shared standards that define success and progress. The multi-pronged approach announced today aims to increase primary care investment without increasing the total cost of healthcare or health insurance premiums,” Commissioner Navarro said. “We are grateful to our many partners who shared their data and experience during the process of building these guidelines. Now we ask the public as a whole to share their feedback on this report.”

The department will be accepting public comment on the report until January 25, 2021. Anyone may submit comments via email to DOI-legal@delaware.gov.

The Office of Value-Based Health Care Delivery was created through the passage of Senate Substitute 1 for Senate Bill 116 in 2019. The General Assembly recognized the importance of a strong system of primary care and the need to help bend the healthcare cost growth curve, directing the department to establish the office in order to “reduce health-care costs by increasing the availability of high quality, cost-efficient health insurance products with stable, predictable, and affordable rates,” and charged the office with three tasks:

1. Establish Affordability Standards for health insurance premiums based on recommendations from the Primary Care Reform Collaborative and annually monitor and evaluate these standards;
2. Establish targets for carrier investment in primary care to support a robust system of primary care by January 1, 2025; and
3. Collect data and develop annual reports regarding carrier investments in health care, including commercial reimbursement rates for primary and chronic care services.

The Office is meeting these directives by conducting extensive research on Delaware’s healthcare market, and used that research to inform the development of the interim Affordability Standards, including targets for increased investment in primary care.

Regulated health insurers found to be in violation laws of that prohibit discrimination in mental healthcare, $597K in fees assessed

Insurance Commissioner Trinidad Navarro has announced the completion of the first in a series of Mental Health Parity examinations on health insurers in Delaware. Investigations conducted by the Delaware Department of Insurance uncovered thousands of mental health parity violations, resulting in $597,000 in fines thus far. The exams are ongoing and include each of the four major insurers. The department works with each insurer to correct issues and create a less discriminatory environment in the future. The 2018 passage of SB 230 required companies to submit an initial analysis of mental and behavioral health coverage to the department in 2019, after which the department would include compliance reviews in their annual market conduct exams. A high number of violations was expected due to this being the first assessment by the department.

“After an incredibly thorough review, our team identified many changes that needed to be made to improve parity. Today’s announcement shows that there is more work to do to ensure those seeking mental health care can do so without undue expense or difficulty. I will continue to hold insurers accountable to meet our state’s standards,” said Commissioner Navarro. “Each violation incurred a fine, but it also brought about important conversations that will result in action, and insurers have been cooperative throughout the process and are already making improvements. We will be following up with insurers frequently and expecting substantial progress.”

Mental Health Parity laws, which exist both at the state and federal levels, aim to eliminate coverage discrimination between policyholders seeking mental illness or substance abuse care and those seeking physical care. A lack of parity can prevent a person from pursuing needed care due to cost or limited access, or otherwise make it more expensive or more time intensive than medical visits. Department examinations are critical to uncovering parity issues as consumers may not be aware if they are experiencing disparate treatment when seeking substance abuse or mental health care.

“Everyone deserves equal access to equal treatment. Mental Health Parity has been a priority of mine and the Behavioral Health Consortium. I want to thank Commissioner Navarro and his department for conducting these examinations and advocating for persons suffering with mental health and substance use disorder,” said Lt. Governor Bethany Hall-Long. “Everyone should be able to access the level of care required for the duration and intensity of their behavioral health needs. Persons should be able to access treatment based on the acuity and severity of their health condition or recovery needs and should never be denied treatment due to insurance practices driven by cost and quotas. This practice has adversely impacted outcomes for persons suffering with mental health and addiction.”

“Making progress on mental health parity has been a priority for our office for several years,” said Navarro, “but this year has emphasized the importance of this task. COVID-19, and all the stress, isolation, anxiety, and grief that has come with it has amplified the need for mental health care access, while also in many ways destigmatizing utilization of services.”

In general, the violations found in policies and practices revolved around a lack of parity between mental health and medical/surgical procedures, medications and procedure preauthorization requirements. Mental health patients often had to meet higher standards for Non-Quantitative Treatment Limitation (limits on the scope or duration of benefits) than other patients, and pharmacy requirements appeared to differ as well. The companies are working to resolve these differences.

Shortlisted for European Captive Review honor

Insurance Commissioner Trinidad Navarro shared today that Delaware was named as one of three finalists for International Insurance Domicile of the Year within the European Captive Review Awards. The winning domicile will be announced in a virtual ceremony on November 26. Delaware is the fifth largest global captive domicile. Commissioner Navarro commended his staff and highlighted their experience and fluency in multiple languages as key attributes to the department’s success.

“With speakers of French, German, Lithuanian, Russian, and Spanish, and decades of experience in international captive matters, the Delaware Department of Insurance Captive Division has a worldwide presence that far exceeds our size,” said Commissioner Navarro, adding that the department’s work on international regulation is prominent in the industry. “Our team participates in supervisory colleges with other jurisdictions around the world to successfully coordinate insurance regulation on a global scale.”

In addition to the recent short-list announcement, the department’s captive team is one of only four captive domiciles to be trained and certified by the International Center for Captive Insurance Education. In 2019, Delaware was named a finalist for Non-Asian Domicile of the Year by leading industry magazine Captive Review.

To learn more about the Delaware Department of Insurance Captive Division, visit captive.delaware.gov.

Decrease and Workplace Safety Program save businesses money during unprecedented time

Insurance Commissioner Trinidad Navarro announced today that workers’ compensation insurance rates will decrease for the fourth year in a row, effective December 1, 2020. The voluntary market is seeing yet another double-digit decrease in loss costs, with an average 11.56% reduction, and residual market rates will go down an average of 8.8%.

“For four consecutive years we have been able to decrease workers’ compensation costs for businesses of all sizes. This year’s reduction will help decrease business expenses as we continue to experience the economic effects of the COVID-19 pandemic,” said Commissioner Navarro. “These lower costs can attract new companies to our state and increase employment opportunities as many organizations look to move out of major metropolitan areas.”

The Delaware Compensation Rating Bureau (DCRB) approved the lower rates after discussion with the Department of Insurance and the State’s Ratepayer Advocate. The approval process includes a review by actuaries for the parties, as well as a public hearing. It is important to note that actual savings may differ and will vary by policy. Last year’s decreases saved businesses more than $4 million in premiums.

These lower rates are just one component of several efforts shepherded by the Department to help businesses financially. More than 1,100 employers are saving even more money on their workers’ compensation premiums by participating in the department’s Workplace Safety Program. Last year’s savings was approximately $7.6 million. Eligible businesses can earn up to a 19% discount on their insurance by providing and maintaining a safe place to work.

“Now more than ever, increasing workplace safety and decreasing business overhead is so important,” said Commissioner Navarro. “Our inspectors are working extremely hard to negotiate challenges caused by COVID-19 and are doing an impressive job completing safety audits during these extraordinarily unusual circumstances. I want to commend them and our entire Workplace Safety team for their incredible work.”

Eligible businesses are notified about the program each year seven months prior to their renewal date, but late applications are being accepted as many businesses were closed when they were notified of their eligibility. Organizations interested in participating can access questionnaires online and contact safety@delaware.gov to begin the process.

Interested employers are urged to note on their questionnaires their current hours and best point of contact if these have been adjusted due to COVID-19 so inspectors can plan site visits. A physical walkthrough is still required for employers to earn a safety discount. Only benefits can be gained by participating, failure to qualify cannot be the basis for premium increases or sanctions imposed by other safety enforcement officials.

View the DCRB website