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Augusta, Maine -

Superintendent of Insurance Mila Kofman has announced that the Bureau of Insurance is implementing a new emergency rule to ensure that all health insurance companies offering policies in Maine are adequately prepared to deal with public health emergencies. The Bureau’s action follows the Superintendent’s review of health carriers’ emergency preparedness.

“The Centers for Disease Control and Prevention (CDC) has warned that the current H1N1 influenza outbreak continues to pose a threat that could worsen or recur in a more serious form. With that in mind, the Bureau analyzed how health insurance companies would address a significant public health emergency,” Superintendent Kofman commented. “Although some Maine insurers are very well prepared, others are lacking in certain respects. As a result of our review, it was determined that additional standards are necessary to protect the public, with immediate steps taken to ensure that effective procedures are in place before an emergency strikes.”

Kofman explained that the review considered key elements of disaster planning reports developed by insurance industry trade associations. She said the rule builds on those standards, and will require insurers to have processes in place that would remove barriers for covered persons to access needed medical services quickly should a large-scale public health problem occur. Specific standards are set forth in section 5 of the rule, which accompanies this press release.

Additionally, the rule requires health insurers to submit information to the Bureau that will facilitate coordination between public agencies and health carriers should a health emergency develop, and provide assurance that each carrier doing business in Maine is ready to fulfill its role in addressing the emergency. Specific standards are set forth in section 6 of the rule.

Because the emergency rule can only remain in effect for 90 days, a proposed rule to establish permanent standards will be forthcoming. It will go through the standard rulemaking procedure, with public notice, a hearing and comment period.

The emergency rule is below. More information about H1N1 from Maine CDC is available online at www.maine.gov/dhhs/boh/swine-flu-2009.shtml. Information can also be obtained from the U.S. CDC at www.cdc.gov/h1n1flu/update.htm, including confirmed cases by state and a reference to the World Health Organization's action last week to raise the pandemic alert level.

The Bureau of Insurance is part of the Department of Professional and Financial Regulation, which encourages sound ethical business practices through regulation of insurers, financial institutions, creditors, investment providers, and numerous professions and occupations for the purpose of protecting the citizens of Maine. Consumers can reach the Bureau through its web site at www.maine.gov/insurance; by calling 800-300-5000 in state; or by writing to Bureau of Insurance, 34 State House Station, Augusta, ME 04333.

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02 DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION

031 BUREAU OF INSURANCE

CHAPTER 765: HEALTH INSURANCE EMERGENCY PLANNING AND PROCEDURES (EMERGENCY RULE)

Table of Contents

SECTION 1. Authority (Emergency Rulemaking)

SECTION 2. Purpose

SECTION 3. Applicability and Scope

SECTION 4. Definitions

SECTION 5. Standards of Emergency Preparedness

SECTION 6. Contingency Planning Requirements

SECTION 7. Reporting Requirements

SECTION 8. Effective Date

SECTION 1. AUTHORITY (EMERGENCY RULEMAKING)

This Rule is adopted by the Superintendent pursuant to 24-A M.R.S.A. §§ 211, 212, 471, 472, 478, 4309 and Title 5 M.R.S.A. § 8054.

Title 5 M.R.S.A. § 8054(2) provides that any emergency rule must include, with specificity, the agency’s findings with respect to the existence of an emergency, including any modifications of procedures. The Superintendent has reviewed the mechanisms currently in place to coordinate the activities of carriers offering health plans, the Bureau of Insurance, other state and federal agencies, and medical providers during a public health emergency. The Superintendent has determined that if an insurance emergency were to be declared at the present time due to a public health crisis, there are some health insurance carriers offering health plans in Maine that would not be prepared to respond appropriately. Therefore, the Superintendent has determined that the mechanisms currently in place are inadequate to ensure that Maine citizens continue to have access to medical benefits during a public health emergency. Emergency rulemaking is necessary because the Maine Center for Disease Control and Prevention has warned that the current H1N1 influenza outbreak poses an immediate threat that could worsen or recur in a more serious form. In order to avoid the immediate threat of Maine’s insurers being unable to respond to such an outbreak, the Superintendent finds it necessary to modify the rulemaking procedures and to adopt this rule without holding a public hearing, receiving public comment, and providing notices thereof as otherwise required by 5 M.R.S.A. §§ 8052-8053.

SECTION 2. PURPOSE

The purpose of this Rule is to establish requirements and procedures for carriers offering health plans to prepare for public health emergencies.

SECTION 3. APPLICABILITY AND SCOPE

This Rule applies to any carrier offering a health plan in Maine, as defined at 24-A M.R.S.A. § 4301-A, a Medicare supplement plan, or a dental insurance plan.

SECTION 4. DEFINITIONS

For purposes of this Rule, “Public Health Emergency” means an existing or imminent likelihood of need for a significant increase in health care services or insurance benefit payments due to injuries or sickness.”

SECTION 5. STANDARDS OF EMERGENCY PREPAREDNESS

Carriers subject to this rule must be capable of implementing the following actions within 72 hours in the event that the Superintendent issues a direction, rule, or order to do so pursuant to 24‑A M.R.S.A. § 478.

1. Suspension of plan rules for prior medical authorization, pre-certification, and utilization review.

2. Suspension of plan requirements for accessing prescription drugs, including prior approval requirements, refill limitations, and co-payments.

3. Suspension of incentives or requirements for enrollees to obtain health services from contracted network providers.

4. Waivers of rate increases, extensions of grace periods, extensions of coverage for employees losing group coverage, and easing of enrollment requirements.

5. Waiver of cost barriers for accessing needed services, including co-payments, co-insurance, and deductibles.

6. Waiver of time limits for filing claims.

SECTION 6. CONTINGENCY PLANNING REQUIREMENTS

Within 30 days after the effective date of this Rule, carriers offering health, Medicare supplement, or dental insurance plans in this state shall provide the Superintendent with the following information.

1. The name and contact information for an officer of the company primarily responsible for public insurance emergency planning in Maine. If this contact information changes the carrier shall notify the Superintendent within 72 hours.

2. A description of health, Medicare supplement, and dental insurance coverage in force in Maine, which must be updated at least annually. Carriers shall provide updated descriptions within 72 hours after a request by the Superintendent. At a minimum, the description must include the following:

   i. The number of group and blanket policy enrollees.

   ii. The number of individual policy enrollees.

   iii. The number of enrollees who have coverage for prescription medications.

   iv. The number of enrollees who have coverage for influenza and pneumococcal vaccinations.

3. A description of the carrier’s plans for assuring adequate staffing and business continuity during a public health emergency.

4. A description of the carrier’s plans for working closely with state and federal regulatory and emergency agencies to respond to the needs of enrollees and the public during a public health emergency.

5. A description of the carrier’s plans for providing enrollees and providers with essential information during a public health emergency.

6. A description of the carrier’s assessment and planning to address increased need and decreased availability of medical supplies, prescription drugs and vaccinations during a public health emergency.

7. A description of the carrier’s contingency plans for minimizing barriers for enrollees to access health care services and health insurance benefits during a public health emergency, including the carrier’s own guidelines for deciding when to implement contingency plans. The plans and guidelines must be flexible and must include specific actions to assist the public in maintaining access to health care services and health insurance benefits depending on the nature, scope, and extent of the emergency. At a minimum contingency plans and guidelines must include the ability to implement the actions described in Section 5 of this Rule within 72 hours after a direction, rule, or order to do so issued pursuant to 24-A M.R.S.A. § 478.

SECTION 7. REPORTING REQUIREMENTS

1. Carriers with health, Medicare supplement, or dental insurance plans covering Maine residents shall promptly provide any information requested by the Superintendent regarding an existing or potential public health emergency, including claims information.

2. Carriers offering health, Medicare supplement, or dental insurance plans in Maine shall file reports meeting the requirements of Section 6 within 30 days after the effective date of this Rule. Reports shall be verified by the oath of the officer designated in Section 6, subsection 1 of this Rule and by one other principal officer of the carrier. Updated reports shall be provided to the Superintendent within 72 hours after a request made to address an existing or potential public health emergency.

SECTION 8. EFFECTIVE DATE

This Rule is effective ______ and pursuant to 5 M.R.S.A. § 8054(3) shall remain effective until ninety (90) days thereafter.

The Bureau of Insurance is part of the Department of Professional and Financial Regulation which encourages sound ethical business practices through high quality, impartial and efficient regulation of insurers, financial institutions, creditors, investment providers, and numerous professions and occupations for the purpose of protecting the citizens of Maine. Consumers can reach the Bureau through its web site at www.maine.gov/insurance; by calling 800-300-5000 in state; or by writing to Bureau of Insurance, 34 State House Station, Augusta ME 04333.

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Last Updated: October 28, 2009 1:29 PM