Lance's Corner

DFS Issues Draft Regulations Requiring Health Insurers to Collect Voluntarily Disclosed Demographic Data

Sep 10, 2024

Per the notice below, the New York State Department of Financial Services (DFS) has issued draft regulations for public comment on requiring health insurers to collect voluntarily disclosed demographic data.

Superintendent Adrienne A. Harris Proposes Health Equity Regulation Requiring Insurers to Collect Voluntarily Disclosed Demographic Data

Regulation Builds on the Superintendent’s Commitment to Health Equity through the Elimination of Cost-Sharing for Insulin and Proposed Regulation to Increase Access for Mental Health and Substance Use Disorder Services

Today, the New York State Department of Financial Services (DFS) continued its work to close the health equity gap and reduce health disparities with a new proposed regulation.  The proposed regulation requires health insurers to request race, ethnicity, preferred language, sexual orientation, and gender identity data, ensuring critical self-reported data is available to more clearly understand insurance benefit use and develop policy solutions to better serve the needs of all New Yorkers, including underrepresented communities.  Policyholders will have the option to provide this information through a questionnaire administered separately from the application process, and this demographic data will aid insurers in identifying and remediating disparities in care that underserved populations receive.  Today’s announcement builds on the work that DFS has already done to advance health equity in the state of New York, taking a data-driven approach to increase access and affordability to critical services.  Earlier this year, the Department worked to develop and advance the Governor’s initiative to eliminate cost-sharing for insulin and proposed new regulations to increase access to mental health and substance use disorder services.

“Having robust information that can be used to develop data-driven policy solutions is essential to combatting discrimination and addressing systemic health inequities,” said Superintendent Harris.  “By identifying populations that may not be fully utilizing their health insurance benefits, insurers and the Department can better direct resources where they are most needed and draw critical insights to ensure that all New Yorkers receive the health care they deserve.”

The regulation prohibits insurers from using the data for unfair or unlawful discriminatory purposes, including eligibility, rate setting, and underwriting determinations, and requires insurers to collect the data in a separate and supplemental questionnaire at the time of application for new insureds or at renewal for current insureds.  Any rate filing or rate manual submission by an insurer must include an attestation to the Department that the insurer is complying with the data usage restrictions.  Consistent with best practices in demographic data collection, the proposed regulation promotes the collection of self-reported data while ensuring consumer responses to questions are optional.  The proposed regulation, which applies to insurers licensed to write accident and health insurance in New York, not-for-profit insurance corporations, health maintenance organizations certified under the Public Health Law, and student health plans, is subject to a 10-day pre-proposal comment period beginning today, followed by a 60-day comment period upon publication in the State Register.  DFS looks forward to, and appreciates receiving feedback on, the proposed regulation during the comment period.  To review the proposed regulation, go here: Draft Insurance Regulations on Health Insurers Gathering Demographic Data or visit the DFS website.

Description and Documents  Date PostedOutreach Comments Due By         Agency Contact
Draft Pre-proposed Rule Making for the 67th Amendment to Insurance Regulation 62 (11 NYCRR 52)September 10, 2024September 20, 2024HealthRegComments@dfs.ny.gov

USDOL Issues Comprehensive Employer Guidance on Long COVID

The United States Department of Labor (USDOL) has issued a comprehensive set of resources that can be accessed below for employers on dealing with Long COVID.

Supporting Employees with Long COVID: A Guide for Employers

The “Supporting Employees with Long COVID” guide from the USDOL-funded Employer Assistance and Resource Network on Disability Inclusion (EARN) and Job Accommodation Network (JAN) addresses the basics of Long COVID, including its intersection with mental health, and common workplace supports for different symptoms.  It also explores employers’ responsibilities to provide reasonable accommodations and answers frequently asked questions about Long COVID and employment, including inquiries related to telework and leave.

Download the guide

Accommodation and Compliance: Long COVID

The Long COVID Accommodation and Compliance webpage from the USDOL-funded Job Accommodation Network (JAN) helps employers and employees understand strategies for supporting workers with Long COVID.  Topics include Long COVID in the context of disability under the Americans with Disabilities Act (ADA), specific accommodation ideas based on limitations or work-related functions, common situations and solutions, and questions to consider when identifying effective accommodations for employees with Long COVID.  Find this and other Long COVID resources from JAN, below:

Long COVID, Disability and Underserved Communities: Recommendations for Employers

The research-to-practice brief “Long COVID, Disability and Underserved Communities” synthesizes an extensive review of documents, literature and data sources, conducted by the USDOL-funded Employer Assistance and Resource Network on Disability Inclusion (EARN) on the impact of Long COVID on employment, with a focus on demographic differences.  It also outlines recommended actions organizations can take to create a supportive and inclusive workplace culture for people with Long COVID, especially those with disabilities who belong to other historically underserved groups.

Read the brief

Long COVID and Disability Accommodations in the Workplace

The policy brief “Long COVID and Disability Accommodations in the Workplace” explores Long COVID’s impact on the workforce and provides examples of policy actions different states are taking to help affected people remain at work or return when ready.  It was developed by the National Conference of State Legislatures (NCSL) as part of its involvement in USDOL’s State Exchange on Employment and Disability (SEED) initiative.

Download the policy brief

Understanding and Addressing the Workplace Challenges Related to Long COVID

The report “Understanding and Addressing the Workplace Challenges Related to Long COVID” summarizes key themes and takeaways from an ePolicyWorks national online dialogue through which members of the public were invited to share their experiences and insights regarding workplace challenges posed by Long COVID.  The dialogue took place during summer 2022 and was hosted by USDOL and its agencies in collaboration with the Centers for Disease Control and Prevention and the U.S. Surgeon General.

Download the report

Working with Long COVID

The USDOL-published “Working with Long COVID” fact sheet shares strategies for supporting workers with Long COVID, including accommodations for common symptoms and resources for further guidance and assistance with specific situations.

Download the fact sheet

COVID-19: Long-Term Symptoms

This USDOL motion graphic informs workers with Long COVID that they may be entitled to temporary or long-term supports to help them stay on the job or return to work when ready, and shares where they can find related assistance.

Watch the motion graphic

A Personal Story of Long COVID and Disability Disclosure

In the podcast “A Personal Story of Long COVID and Disability Disclosure,” Pam Bingham, senior program manager for Intuit’s Diversity, Equity and Inclusion in Tech team, shares her personal experience of navigating Long COVID symptoms at work.  The segment was produced by the USDOL-funded Partnership on Employment and Accessible Technology (PEAT) as part of its ongoing “Future of Work” podcast series.

Listen to the podcast

HHS OIG Issues Annual Report on State MFCUs

Per the notice below, the Office of the Inspector General (OIG) of the United States Department of Health and Human Services (HHS) has issued its annual report on the performance of state Medicaid Fraud Control Units (MFCUs).

Medicaid Fraud Control Units Fiscal Year 2023 Annual Report (OEI-09-24-00200) 

Medicaid Fraud Control Units (MFCUs) investigate and prosecute Medicaid provider fraud and patient abuse or neglect. OIG is the Federal agency that oversees and annually approves federal funding for MFCUs through a recertification process. This new report analyzed the statistical data on annual case outcomes—such as convictions, civil settlements and judgments, and recoveries—that the 53 MFCUs submitted for Fiscal Year 2023.  New York data is as follows:

Outcomes

  • Investigations1 - 556
  • Indicted/Charged - 9
  • Convictions - 8
  • Civil Settlements/Judgments - 28
  • Recoveries2 - $73,204,518

Resources

  • MFCU Expenditures3 - $55,964,293
  • Staff on Board4 - 257

1Investigations are defined as the total number of open investigations at the end of the fiscal year.

2Recoveries are defined as the amount of money that defendants are required to pay as a result of a settlement, judgment, or prefiling settlement in criminal and civil cases and may not reflect actual collections.  Recoveries may involve cases that include participation by other Federal and State agencies.

3MFCU and Medicaid Expenditures include both State and Federal expenditures.

4Staff on Board is defined as the total number of staff employed by the Unit at the end of the fiscal year.

Read the Full Report

View the Statistical Chart

Engage with the Interactive Map

GAO Issues Report on Medicaid Managed Care Service Denials and Appeal Outcomes

The United States Government Accountability Office (GAO) has issued a report on federal use of state data on Medicaid managed care service denials and appeal outcomes.  GAO found that federal oversight is limited because it doesn't require states to report on Medicaid managed care service denials or appeal outcomes and there has not been much progress on plans to analyze and make the data publicly available.  To read the GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the first link below.  To read GAO highlights of the report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the second link below.
https://www.gao.gov/assets/d24106627.pdf  (GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes)
https://www.gao.gov/assets/d24106627_high.pdf  (GAO highlights on federal use of state data on Medicaid managed care service denials and appeal outcomes)

CMS Issues Latest Medicare Regulatory Activities Update

The Centers for Medicare and Medicaid Services (CMS) has issued its latest update on its regulatory activities in the Medicare program.  While dentistry is only minimally connected to the Medicare program, Medicare drives the majority of health care policies and insurance reimbursement policies throughout the country.  Therefore, it always pays to keep a close eye on what CMS is doing in Medicare.  To read the latest CMS update on its regulatory activities in Medicare, use the link below.
https://www.cms.gov/training-education/medicare-learning-network/newsletter/2024-03-14-mlnc