Government Affairs

IAHU represents all members with one unified and strong voice. On-going legislative and agency lobbying, a top priority of our Association will be designed to educate those who regulate our industry.

BULLETIN 20-04

To:       All Health Insurance Companies Writing in the State of Iowa
From:   Doug Ommen, Iowa Insurance Commissioner
RE:     Individual and Small Group Coverage Impacted by COVID-19
Date:    March 19, 2020

In light of Governor Reynolds’s March 17, 2020 proclamation of a State of Public Health Disaster Emergency (the “Proclamation”), the purpose of Bulletin 20-04 is to assist individuals and entities regulated by the Iowa Insurance Division who are impacted by the COVID-19 epidemic and the resulting economic disruptions.The Commissioner requests all health insurers and health maintenance organizations licensed in this state to allow a premium payment grace period for any Iowa individual health benefit plan as defined in Iowa Code section 513C.3 and to any health benefit plan issued to small employers under Iowa Code chapter 513B as follows:

• Health insurers and health maintenance organizations are requested to put procedures in place allowing individual and small employer policyholders affected by the economic disruptions resulting from COVID-19 to request extensions for premium payments beyond the insurers’ normal payment due dates.
• Health insurers and health maintenance organizations are requested to allow any individual or small group policyholder at least 60 days after a premium payment is due before terminating coverage for any such policyholder who has a premium payment initially due between March 17, 2020, and June 30, 2020.
• To the extent that federal law requires a longer or shorter period for payment of premiums, federal law shall control. However, in light of the Proclamation, the Commissioner requests that issuers on the Federally Facilitated Exchange extend premium payment deadlines (such as deadlines for payment to effectuate coverage) and delay cancellations for non-payment of premium that are at least consistent with this Bulletin. The Division further requests that CMS exercise enforcement discretion regarding any provisions of federal law inconsistent with this Bulletin pursuant to section 7.1.4 of the Federally-facilitated Exchanges (FFEs) and Federally-facilitated Small Business Health Options Program (FF-SHOP) Enrollment Manual.
• For those policies with an automatic bank draft or electronic funds transfer arrangement, health insurers and health maintenance organizations may continue payment deductions unless or until the policyholder terminates this arrangement with the insurer and financial institution.

The Division is not requesting that health insurers or health maintenance organizations waive any premiums or other consideration owed on any policy or contract. Nothing in this Bulletin should be construed as the Division requesting any health insurer or health maintenance organization to refrain from terminating coverage on the basis of fraud on the part of an insured.

We will update you as we get more information. Please watch for information to come from the insurance companies on how these will be handled.

Bills that passed the House

HF 2553 PHARMACY BENEFIT MANAGERS 

Establishes requirements for a Pharmacy Benefit Manager to place a drug on the Maximum Allowable Cost list, including that the drug is available to pharmacies statewide. Requires a pharmacy have access to the list. Requires a PBM to update the list within seven days due to changes in acquisition cost or cost methodology. Prohibits a PBM from paying a pharmacy less for a prescription drug than it pays PBM affiliates. Requires that a PBM have an appeals process, with a dedicated phone and internet site. Prohibits PBM from requiring pharmacies to meet accreditation standards or surety requirements beyond state and federal requirements. Prohibits spread pricing and defines such pricing. Prohibits PBM from barring pharmacies from using direct delivery or mail delivery. Includes provisions barring PBMs from retroactively reducing claims. Commissioner: Requires the Insurance Commissioner to review PBM compensation to pharmacies and to adopt rules and take enforcement actions. Other: Makes the bill severable. Repeals some current enforcement provisions and makes conforming changes. 

The House PASSED the bill 100-0; it now GOES to the Senate 

HF 2138 INSULIN PRESCRIPTION COSTS 

Requires insurance coverage for prescription drugs to cap cost-sharing for insulin prescriptions at no more than $100 for a 30-day supply of insulin. 

H 8016 by A Meyer - Makes the supply period 31 days. ADOPTED 

H 8115 to H 8016 by James - Reduces the cost to $50. RULED NOT GERMANE; MTSR FAILED 53-46 

The House PASSED the bill as amended 98-1; it now GOES to the Senate 

HF 2192 TELEHEALTH PAYMENTS 

Requires health carriers to reimburse health care providers for telehealth services at the same rate as in-person services as of January 2021. 

H 8028 by Fry - Requires tele-health procedures to be in real-time. Prohibits the health carrier from requiring additional health care professionals to be present. ADOPTED 

H 8035 to H 8028 by Fry - Corrective. ADOPTED 

The House PASSED the bill as amended 99-0; it now GOES to the Senate 

Amendments to Insulin Bill - HF2138 - Amendment was to remove all insulin drugs to at least one in each type of rapid-acting prescription insulin drugs, short-acting prescription insulin drugs, intermediate-acting prescription insulin drugs, or long-acting prescription insulin drugs. For information follow this link: https://www.legis.iowa.gov/legislation/BillBook?ga=88&ba=HF%202138

The following bills were released that are related to health care:

Continuity of Care - HF2089 & SSB3117 - This bill provides that during a covered person's eligibility under a health benefit plan, inclusive of any open enrollment period, a health plan carrier, health benefit plan, or utilization review organization shall not limit or exclude coverage of a prescription drug for the covered person if the covered person is medically stable on the drug as determined by the prescribing health care professional, the drug was previously approved by the health carrier for coverage for the person, and the person's prescribing health care professional has prescribed the drug for the covered person's medical condition within the previous six months. For more information follow these links: https://www.legis.iowa.gov/legislation/BillBook?ga=88&ba=hf2089 AND https://www.legis.iowa.gov/legislation/BillBook?ba=SSB3117&ga=88

Drug Transparency - HF2253 - This bill requires a manufacturer to file an annual report with the commissioner of insurance that discloses the wholesale acquisition cost for all prescription drugs manufactured by the manufacturer that were sold to a person in the state in the immediately preceding calendar year. For more information follow this link: https://www.legis.iowa.gov/legislation/BillBook?ba=HF2253&ga=88

Civil Action - Providers - HSB596 - The bill eliminates the exception to the limitation of $250,000 that would allow the jury to determine if the imposition of such a limitation would deprive the plaintiff of just compensation for the injuries sustained. For more information follow this link: https://www.legis.iowa.gov/legislation/BillBook?ga=88&ba=hsb596

SSB 3047 - 1332 Waiver

This bill relates to health insurance and the insurance division of the department of commerce. The bill authorizes the commissioner of insurance to develop by rule a state innovation waiver pursuant to section 1332 of the federal Patient Protection and Affordable Care Act, Pub. L. No. 111-148, and to submit an application on behalf of the state to the United States secretary of health and human services and the United States secretary of the treasury for the waiver. IAHU is in support of this current Senate Study Bill. Read more details here:  https://www.legis.iowa.gov/legislation/BillBook?ga=88&ba=SSB%203047 Reach out to Marcie Strouse with any questions. 

HSB 501 - Prescription Insulin drugs

This bill relates to prescription insulin drugs and coverage by policies, contracts, or plans providing for third-party payment or prepayment of health or medical expenses that provide coverage for prescription drugs. The bill requires a policy, contract, or plan providing for third-party payment of prepayment of health or medical expenses that provides coverage for prescription drugs to cap the total amount of cost-sharing that a covered person is required to pay for a prescription insulin drug to an amount not more than $100 for a 30-day supply, regardless of the amount or type of prescription insulin drug required to fill the covered person's prescription. IAHU is undecided at this time. Read more details here: https://www.legis.iowa.gov/legislation/BillBook?ga=88&ba=HSB%20501 Reach out to Marcie with any questions. 

State Legislative Links
Iowa Legislature
State Action Center - Find your State Legislator
Iowa Insurance Division

Federal Legislative Links
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NAHU Federal Action Center – Keep up to date on all the legislation
Compliance Corner – Need help with a compliance question?
Podcasts – Quick audio updates on the most important issues
Broker to Broker (B2B) – This is a great resource to work with agent and brokers across the country
NAHU Home – Looking for your Federal Legislators

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