Mississippi State Flexibility to Stabilize the Market Grant Award

Grant Application Summary

Mississippi Grantee: Mississippi Insurance Department

Award Date: August 20, 2018

Total Award: $279,734.10

Baseline Award: $274,344.83

Workload Award: $5,389.27

Section 2702 - The Mississippi Insurance Department will ensure availability of coverage by enhancing the review process of health insurance issuer form filings. Mississippi will retain legal consultants to review the current requirements under the Affordable Care Act (ACA), the Public Health Service Act (PHS Act), and related Federal regulations. The Mississippi Insurance Department will work with the consultants to formulate a thorough policy form review procedure and, if necessary, develop and provide additional guidance to issuers in the form of bulletins and/or regulations that outline the requirements for full compliance.

Section 2703 - The Mississippi Insurance Department will ensure renewability of coverage by enhancing the review process of health insurance issuer form filings. Legal consultants will be retained to review the current requirements under the Affordable Care Act (ACA), the Public Health Service Act (PHS Act), and related Federal regulations. Mississippi will work with the consultants to formulate a thorough policy form review procedure that will outline the requirements for full compliance and, if necessary, develop and provide additional guidance to issuers in the form of bulletins and/or regulations that outline the requirements for full compliance.

Section 2707 – The Mississippi Insurance Department will enhance existing policy filing review processes to ensure health insurance issuers’ drug formularies are not discriminatory and are compliant with State and Federal laws. As part of its plan to address issues of formulary discrimination, Mississippi will research and determine the best effective review tool and process for drug formularies. The Mississippi Insurance Department will perform a feasibility study to determine whether implementing drug formularies can be done by department personnel. Mississippi will contract with licensed clinicians to review the numerous justifications of non-discrimination that carriers assert in their drug formularies. Additionally, Mississippi will conduct meetings with representatives of key health insurance issuers from around the State to assist in establishing effective training and procedures for reviewing drug formularies to ascertain compliance. The clinicians will work with Mississippi Insurance Department personnel and its legal consultants to establish expanded non-discrimination guidelines for prescription drug formularies that will aide Mississippi’s actuaries with ongoing policy form review. Grant funds will be used to evaluate the effectiveness of currently available review tools, and to develop new and innovative tools to assist with and render the existing processes more efficient. This enhancement and implementation work will include canvassing of processes and tools developed and used by other states. The Mississippi Insurance Department will research and review these processes to determine the effectiveness of their application to the Mississippi health insurance market.