Lance's Corner

DFS Adopts Final Health Equity Regulation

Apr 2, 2025

The New York State Department of Financial Services (DFS) has finally adopted its health equity regulation.  The regulation requires health insurers to request voluntarily disclosed information regarding an applicant’s, insured’s, and an insured’s covered dependent’s race, ethnicity, preferred language, sexual orientation, and gender identity or expression.  The data collected may not be used in a manner that is unfairly or unlawfully discriminatory and may not be used by an insurer in underwriting or rating decisions.  Only aggregated, anonymized data will be used by insurers and the DFS to study potential health equity issues in health insurance and to improve access to health care services.  You can read the DFS guidance on the new health equity regulation here: https://www.dfs.ny.gov/industry_guidance/health-equity.  You can read the following DFS regulatory materials adopting the new regulation: 1) the actual regulatory language -- DFS Final Adoption of Health Equity Regulation; 2) the DFS assessment of public comments on the regulation --  DFS Assessment of Public Comments on Health Equity Regulation; and 3) the DFS regulatory filings accompanying the Notice of Adoption in the April 2, 2025, New York State Register --  DFS Regulatory Filing on Final Health Equity Regulation.

Superintendent Adrienne A. Harris Strengthens Commitment to Health Equity with New Regulation Requiring Insurers to Collect Voluntarily Disclosed Demographic Data

Superintendent Adrienne A. Harris today announced that the New York State Department of Financial Services (“DFS” or “Department”) has adopted a new regulation to reduce disparities in health care access and use across New York.  This adopted rule requires health insurers to request voluntarily disclosed demographic data, such as race, ethnicity, preferred language, sexual orientation, and gender identity, ensuring critical self-reported data is available to better understand insurance benefit use and develop policies that serve the needs of all New Yorkers, especially underserved communities.

"We cannot adequately address health disparities without robust data and information," said Superintendent Harris.  "By analyzing trends in health care utilization, the Department can identify populations that may not be fully using their benefits, and direct resources where needed so that New Yorkers receive the quality care they need and deserve."

Under the new rule, insureds will have the option to provide this information through a separate questionnaire, administered apart from the application or renewal process.  The Department will use this data to identify and address any systemic disparities in benefit use.  The regulation expressly prohibits insurers from using the data for unfair or unlawful discriminatory purposes, including eligibility, rate-setting, and underwriting determinations.  Insurers will be required to attest in writing to the Department on a regular basis that they are complying with the data usage restrictions.

The Department is committed to advancing health equity in the state of New York.  In 2024, 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.  The adopted regulation 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.  To support compliance, DFS has developed a standard template that insurers can use to collect demographic information.  The template mirrors demographic language used by the New York State of Health and Centers for Medicaid and Medicare Services.  DFS developed this regulation through extensive outreach to industry leaders, health plans, state and federal regulators, and the general public.  To review the adopted regulation and template, visit the Department’s health equity landing page.

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