New State Laws Require More Preventive Services From Insurers

By Judy Packer-Tursman

A bevy of new state laws pertaining to health insurers took effect Jan. 1. It all adds up to a year of potentially higher costs for plans, with some states entering 2019 by protecting various Affordable Care Act (ACA) provisions by statute — and even more of them eying how to take advantage of the ACA's state innovation waivers as the year progresses.

• In Minnesota, its statute now permits "certified reinsurers" not licensed in that state to work in the state if they meet certain bookkeeping and financial strength requirements. Another new law in Minnesota sets up a step therapy override process, under which a health plan enrollee and prescribing health care provider can override an insurer's step therapy protocol.
• In New York, a law effective Jan. 1 requires health insurers to provide men with access to prostate cancer screening without copays or deductibles. The law also requires plans to make consumers aware of the new benefit.
• In Louisiana, a new law requires plans to cover follow-up preventive cancer screenings on at least an annual basis after a woman who has had a bilateral mastectomy following a breast cancer diagnosis finishes her active treatment.
• In Illinois, a law effective Jan. 1 requires insurers to provide "coverage for medically necessary expenses for standard fertility preservation services when a necessary medical treatment may directly or indirectly cause iatrogenic infertility to an enrollee."
• In New Jersey, a new law called the Health Insurance Market Preservation Act creates a tax to encourage residents to buy insurance. 

State innovation waivers under the ACA are likely to be a hot topic among state lawmakers this year, says Richard Cauchi at the National Conference of State Legislatures. In its upcoming legislative session, Wyoming is likely to become the first state this year to move forward on a federal application for a reinsurance program through the Section 1332 waiver, he notes.

In the first two years such waivers were allowed, 20 states enacted laws as the first step, Cauchi notes. Yet, as of Jan. 1, 2019, "just eight states have received HHS approval — with seven of those establishing state reinsurance programs that allow use of some federal and state funds resulting in some lower premiums for policies sold through exchanges."

Meanwhile, seven other states have enacted legislation to apply for a reinsurance waiver, but their requests have not yet been filed or approved.

From Health Plan Weekly