2015 -- H 5700

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LC001629

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2015

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A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES--

MEDICAL LOST RATIO REPORTING

     Introduced By: Representatives Naughton, Tanzi, Handy, Ajello, and Canario

     Date Introduced: February 26, 2015

     Referred To: House Corporations

     It is enacted by the General Assembly as follows:

     SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness

Insurance Policies" is hereby amended by adding thereto the following section:

     27-18-82. Medical loss ratio reporting. – (a) A health care service plan that issues, sells,

renews, or offers a specialized health care service plan contract covering dental services shall, no

later than September 30, 2016, and each year thereafter, file a report, which shall be known as the

medical loss ratio (MLR) annual report, with the department of health that is organized by market

and product type and contains the same information required in the 2013 federal Medical Loss

Ratio (MLR) Annual Reporting Form (CMS-10418).

     (b) The MLR reporting year shall be for the calendar year during which dental coverage

is provided by the plan. All terms used in the MLR annual report shall have the same meaning as

used in the federal Public Health Service Act 42 U.S.C. §. 300gg-18, and 45 C.F.R. 158.101 et

seq.

     (c) If the health insurance commissioner decides to conduct a financial examination

because the director finds it necessary to verify the health care service plan's representations in

the MLR annual report, office of the health insurance commissioner (OHIC) shall provide the

health care service plan with a notification thirty (30) days before the commencement of the

financial examination.

     (d) The health care service plan shall have thirty (30) days from the date of notification to

electronically submit to the OHIC all requested records, books, and papers specified in § 27-1-11.

The health insurance commissioner may extend the time for a health care service plan to comply

with this subsection upon a finding of good cause.

     (e) The OHIC shall make available to the public all of the data provided to the OHIC

pursuant to this section.

     (f) This section shall not apply to a health care service plan contract issued, sold,

renewed, or offered for health care services or coverage provided by RIteCare or Rhode Island's

Medicaid program, to the extent consistent with the federal Patient Protection and Affordable

Care Act (Pub. L. 111-148).

     (g) It is the intent of the general assembly that the data reported pursuant to this section

be considered by the general assembly in adopting a medical loss ratio standard for health care

service plans that cover dental services that would take effect no later than January 1, 2019.

     (h) Until January 1, 2019, the health insurance commissioner may issue guidance to

health care service plans subject to this section regarding compliance with this section. Any

guidance issued pursuant to this subsection shall be effective only until the health insurance

commissioner adopts regulations pursuant to the administrative procedure act chapter 35 of title

42. The OHIC shall consult with the division of insurance regulation in issuing guidance pursuant

to this subsection.

     SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service

Corporations" is hereby amended by adding thereto the following section:

     27-19-73. Medical loss ratio reporting. – (a) A health care service plan that issues, sells,

renews, or offers a specialized health care service plan contract covering dental services shall, no

later than September 30, 2016, and each year thereafter, file a report, which shall be known as the

medical loss ratio (MLR) annual report, with the department of health that is organized by market

and product type and contains the same information required in the 2013 federal Medical Loss

Ratio (MLR) Annual Reporting Form (CMS-10418).

     (b) The MLR reporting year shall be for the calendar year during which dental coverage

is provided by the plan. All terms used in the MLR annual report shall have the same meaning as

used in the federal Public Health Service Act 42 U.S.C. §. 300gg-18, and 45 C.F.R. 158.101 et

seq.

     (c) If the health insurance commissioner decides to conduct a financial examination

because the director finds it necessary to verify the health care service plan's representations in

the MLR annual report, office of the health insurance commissioner (OHIC) shall provide the

health care service plan with a notification thirty (30) days before the commencement of the

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financial examination.

     (d) The health care service plan shall have thirty (30) days from the date of notification to

electronically submit to the OHIC all requested records, books, and papers specified in § 27-1-11.

The health insurance commissioner may extend the time for a health care service plan to comply

with this subsection upon a finding of good cause.

     (e) The OHIC shall make available to the public all of the data provided to the OHIC

pursuant to this section.

     (f) This section shall not apply to a health care service plan contract issued, sold,

renewed, or offered for health care services or coverage provided by RIteCare or Rhode Island's

Medicaid program, to the extent consistent with the federal Patient Protection and Affordable

Care Act (Pub. L. 111-148).

     (g) It is the intent of the general assembly that the data reported pursuant to this section

be considered by the general assembly in adopting a medical loss ratio standard for health care

service plans that cover dental services that would take effect no later than January 1, 2019.

     (h) Until January 1, 2019, the health insurance commissioner may issue guidance to

health care service plans subject to this section regarding compliance with this section. Any

guidance issued pursuant to this subsection shall be effective only until the health insurance

commissioner adopts regulations pursuant to the administrative procedure act chapter 35 of title

42. The OHIC shall consult with the division of insurance regulation in issuing guidance pursuant

to this subsection.

     SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service

Corporations" is hereby amended by adding thereto the following section:

     27-20-69. Medical loss ratio reporting. – (a) A health care service plan that issues, sells,

renews, or offers a specialized health care service plan contract covering dental services shall, no

later than September 30, 2016, and each year thereafter, file a report, which shall be known as the

medical loss ratio (MLR) annual report, with the department of health that is organized by market

and product type and contains the same information required in the 2013 federal Medical Loss

Ratio (MLR) Annual Reporting Form (CMS-10418).

     (b) The MLR reporting year shall be for the calendar year during which dental coverage

is provided by the plan. All terms used in the MLR annual report shall have the same meaning as

used in the federal Public Health Service Act 42 U.S.C. §. 300gg-18, and 45 C.F.R. 158.101 et

seq.

     (c) If the health insurance commissioner decides to conduct a financial examination

because the director finds it necessary to verify the health care service plan's representations in

LC001629 - Page 3 of 7

the MLR annual report, office of the health insurance commissioner (OHIC) shall provide the

health care service plan with a notification thirty (30) days before the commencement of the

financial examination.

     (d) The health care service plan shall have thirty (30) days from the date of notification to

electronically submit to the OHIC all requested records, books, and papers specified in § 27-1-11.

The health insurance commissioner may extend the time for a health care service plan to comply

with this subsection upon a finding of good cause.

     (e) The OHIC shall make available to the public all of the data provided to the OHIC

pursuant to this section.

     (f) This section shall not apply to a health care service plan contract issued, sold,

renewed, or offered for health care services or coverage provided by RIteCare or Rhode Island's

Medicaid program, to the extent consistent with the federal Patient Protection and Affordable

Care Act (Pub. L. 111-148).

     (g) It is the intent of the general assembly that the data reported pursuant to this section

be considered by the general assembly in adopting a medical loss ratio standard for health care

service plans that cover dental services that would take effect no later than January 1, 2019.

     (h) Until January 1, 2019, the health insurance commissioner may issue guidance to

health care service plans subject to this section regarding compliance with this section. Any

guidance issued pursuant to this subsection shall be effective only until the health insurance

commissioner adopts regulations pursuant to the administrative procedure act chapter 35 of title

42. The OHIC shall consult with the division of insurance regulation in issuing guidance pursuant

to this subsection.

     SECTION 4. Chapter 27-20.1 of the General Laws entitled "Nonprofit Dental Service

Corporations" is hereby amended by adding thereto the following section:

     27-20.1-23. Medical loss ratio reporting. -- (a) A health care service plan that issues,

sells, renews, or offers a specialized health care service plan contract covering dental services

shall, no later than September 30, 2016, and each year thereafter, file a report, which shall be

known as the medical loss ratio (MLR) annual report, with the department of health that is

organized by market and product type and contains the same information required in the 2013

federal Medical Loss Ratio (MLR) Annual Reporting Form (CMS-10418).

     (b) The MLR reporting year shall be for the calendar year during which dental coverage

is provided by the plan. All terms used in the MLR annual report shall have the same meaning as

used in the federal Public Health Service Act 42 U.S.C. §. 300gg-18, and 45 C.F.R. 158.101 et

seq.

LC001629 - Page 4 of 7

     (c) If the health insurance commissioner decides to conduct a financial examination

because the director finds it necessary to verify the health care service plan's representations in

the MLR annual report, office of the health insurance commissioner (OHIC) shall provide the

health care service plan with a notification thirty (30) days before the commencement of the

financial examination.

     (d) The health care service plan shall have thirty (30) days from the date of notification to

electronically submit to the OHIC all requested records, books, and papers specified in § 27-1-11.

The health insurance commissioner may extend the time for a health care service plan to comply

with this subsection upon a finding of good cause.

     (e) The OHIC shall make available to the public all of the data provided to the OHIC

pursuant to this section.

     (f) This section shall not apply to a health care service plan contract issued, sold,

renewed, or offered for health care services or coverage provided by RIteCare or Rhode Island's

Medicaid program, to the extent consistent with the federal Patient Protection and Affordable

Care Act (Pub. L. 111-148).

     (g) It is the intent of the general assembly that the data reported pursuant to this section

be considered by the general assembly in adopting a medical loss ratio standard for health care

service plans that cover dental services that would take effect no later than January 1, 2019.

     (h) Until January 1, 2019, the health insurance commissioner may issue guidance to

health care service plans subject to this section regarding compliance with this section. Any

guidance issued pursuant to this subsection shall be effective only until the health insurance

commissioner adopts regulations pursuant to the administrative procedure act chapter 35 of title

42. The OHIC shall consult with the division of insurance regulation in issuing guidance pursuant

to this subsection.

     SECTION 5. Chapter 27-41 of the General Laws entitled "Health Maintenance

Organizations" is hereby amended by adding thereto the following section:

     27-41-86. Medical loss ratio reporting. -- (a) A health care service plan that issues,

sells, renews, or offers a specialized health care service plan contract covering dental services

shall, no later than September 30, 2016, and each year thereafter, file a report, which shall be

known as the medical loss ratio (MLR) annual report, with the department of health that is

organized by market and product type and contains the same information required in the 2013

federal Medical Loss Ratio (MLR) Annual Reporting Form (CMS-10418).

     (b) The MLR reporting year shall be for the calendar year during which dental coverage

is provided by the plan. All terms used in the MLR annual report shall have the same meaning as

LC001629 - Page 5 of 7

used in the federal Public Health Service Act 42 U.S.C. §. 300gg-18, and 45 C.F.R. 158.101 et

seq.

     (c) If the health insurance commissioner decides to conduct a financial examination

because the director finds it necessary to verify the health care service plan's representations in

the MLR annual report, office of the health insurance commissioner (OHIC) shall provide the

health care service plan with a notification thirty (30) days before the commencement of the

financial examination.

     (d) The health care service plan shall have thirty (30) days from the date of notification to

electronically submit to the OHIC all requested records, books, and papers specified in § 27-1-11.

The health insurance commissioner may extend the time for a health care service plan to comply

with this subsection upon a finding of good cause.

     (e) The OHIC shall make available to the public all of the data provided to the OHIC

pursuant to this section.

     (f) This section shall not apply to a health care service plan contract issued, sold,

renewed, or offered for health care services or coverage provided by RIteCare or Rhode Island's

Medicaid program, to the extent consistent with the federal Patient Protection and Affordable

Care Act (Pub. L. 111-148).

     (g) It is the intent of the general assembly that the data reported pursuant to this section

be considered by the general assembly in adopting a medical loss ratio standard for health care

service plans that cover dental services that would take effect no later than January 1, 2019.

     (h) Until January 1, 2019, the health insurance commissioner may issue guidance to

health care service plans subject to this section regarding compliance with this section. Any

guidance issued pursuant to this subsection shall be effective only until the health insurance

commissioner adopts regulations pursuant to the administrative procedure act chapter 35 of title

42. The OHIC shall consult with the division of insurance regulation in issuing guidance pursuant

to this subsection.

     SECTION 6. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES--

MEDICAL LOST RATIO REPORTING

***

     This act would create a medical loss ratio reporting requirement for all insurance plans

offering dental coverage in order to create transparency for consumers, and to facilitate the future

establishment of medical loss ratio standards for dental plans.

     This act would take effect upon passage.

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