District of Columbia Health Insurance Enforcement and Consumer Protections Grant Award

Cycle I Grant Application Summary

District of Columbia Grantee: Department of Insurance, Securities, and Banking

Award Date: October 31, 2016

Total Award: $1,138,052.09

Baseline Award: $476,998

Selected Market Reforms Amount: $540,000

Workload Award Amount: $121,054.09

• Section 2707 - The Department of Insurance, Securities, and Banking (the Department) will develop tools and processes to review plans for discriminatory benefit design, as well as for conducting prescription drug formulary reviews. The District of Columbia will gather information and consider potential regulatory changes to ensure non-discrimination under comprehensive health insurance coverage in DC. The Department will also enhance its existing policy filing review processes to ensure health insurance issuers do not include discriminatory benefit designs that discourage people with potentially high cost medical conditions from enrolling in those plans.

• Section 2713 - The Department of Insurance, Securities, and Banking will perform an analysis of coverage of preventive services and prescription drug coverage and compare it to actual utilization trends. In partnership with the Department of Health, the Department will conduct policy form review to ensure coverage of selected benefits and services that address District of Columbia Healthy People 2020 Framework.

• Section 2719 - The District of Columbia will continue with its existing review process. The Department of Insurance, Securities, and Banking will make adjustments to make the process consistent with NAIC standard, and the standards specified in Federal regulations, in an effort to ensure DC meets the December 31, 2017, implementation deadline.

• Section 2726 - The Department of Insurance, Securities, and Banking will expand its review for parity in mental health and substance use disorder benefits by developing tools and processes for more efficient review of mental health parity compliance. The District of Columbia will also look at health insurance coverage of benefits and services for enrollees with co-occurring physical health conditions (chronic diseases) and mental health disorders, as well as instances where there are co-occurring mental health conditions along with substance use disorders. While the Department has sought to review plans for parity, where medical and behavioral health benefits and services are treated equally, this would be the first time the District of Columbia will also look at how these services are coordinated and delivered to high need enrollees.