North Carolina Health Insurance Enforcement and Consumer Protections Grant Award

Cycle I Grant Application Summary

North Carolina Grantee: North Carolina Department of Insurance

Award Date: October 31, 2016

Total Award: $1,114,013.82

Baseline Award: $476,998

Selected Market Reforms Amount: $420,000

Workload Award Amount: $217,015.82

• Section 2713 - The North Carolina Department of Insurance will analyze, research, document, and respond to consumer complaints relating to required benefits under a Qualified Health Plan (QHP) and a non-QHP, and all written inquiries and complaints that relate to preventive health services. The Department of Insurance will train staff to identify, evaluate, and report issues pertaining to preventive health services. North Carolina also plans to produce educational materials regarding preventive health benefits and distribute them across the State in a variety of forums, including speaking engagements and conferences. Additionally, the Department of Insurance’s website will provide information regarding preventive health benefits including an educational video. The Department of Insurance will also analyze Federal laws, guidance issues, and current State laws to identify discrepancies, conflicts, and opportunities for reconciliation, and then draft proposed legislation and/or regulation for adoption.

• Section 2726 - The North Carolina Department of Insurance will improve compliance tools and processes, including facilitating review of quantitative and non-quantitative treatment limits in the benefit categories of Inpatient, Inpatient Out-of-Network, Outpatient, Outpatient Out-of-Network, Emergency Care and Prescription Drugs. The Department of Insurance will improve health insurance issuer compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA) through the analysis, comparison and reconciliation of North Carolina’s current standards with Federal requirements, which will potentially lead to the adoption of enhanced standards consistent with the Federal standards. The Department of Insurance will also evaluate all consumer complaints involving MH/SUD benefits to ensure compliance with the State and Federal Parity Laws. The Department of Insurance will train staff and develop health insurance issuers’ response questions to be used on all complaints that are related to MH/SUD access or claim denial. Finally, the Department of Insurance will promote a statewide consumer education and awareness campaign by targeting outreach to professional partners, associations and organizations, developing outreach educational materials, enhancing information on the Department of Insurance’s website, presenting to various stakeholder groups, participating in statewide conferences, as well as purchasing radio and digital advertising spaces.