CALIFORNIA: Governor Brown signed legislation last week clearing a roadblock for health insurers to disclose cost and quality information to their members about the hospitals they visit. Aetna worked for three years to pass this anti “gag clause” legislation which will help us provide better information to our customers.
Specifically, SB 751 will prohibit a hospital from requiring a provision in its contract with an insurer that would prevent the dissemination and disclosure of cost and quality data.
While the vast majority of hospitals in California already allow this information to be shared, a few were using so-called “gag clauses” in their contracts with health insurers to preclude insurers from sharing cost and quality information with customers.
In other news, during the last week of session the legislature amended an unrelated bill to impose a mandate on health insurers to include coverage for all autism related services and a requirement on insurers to pay unlicensed providers for treatment.
The legislation is on the Governor’s desk and likely to be favorably received since prior to passing the bill, the Senate leadership removed applicability to state programs based on an independent analysis that cited more that $200 million in fiscal costs to state programs like MediCal if the mandate applied to health plans paid for by the state.
IDAHO: Idaho Department of Insurance (“DOI”) issued a press release on September 6, announcing that the Centers for Medicare and Medicaid Services (“CMS”) has reversed its earlier decision and now deems the rate review process in Idaho to be “effective” according to standards adopted pursuant to the Patient Protection and Affordable Care Act (“ACA”).
Under the new rules in Bulletin No. 11-07, issued on September 2, insurers offering individual and small group health benefit plans are now required to submit information justifying rates, which will be made available for public review.
The bulletin’s substantive provisions inform carriers that changes being implemented require new data elements and documentation for rate filings, rate revisions, or justifications of existing rates, beginning September 1, 2011.