Megan Mason

The hearing focused on the submission and processing of clean claims. The Administration sought stakeholder input regarding potential revisions to existing regulations to align with current technological standards. Discussion topics included implementing guardrails for the use of artificial intelligence in claims processing, addressing concerns regarding downcoding, clarifying the clinical criteria supporting emergency department codes, and establishing defined timelines to prevent claims from remaining in an indefinite pending status.

The meeting focused on the definition of specialty drugs and the implications of current coverage requirements. Key discussion topics included concerns regarding pharmacy steering practices, the restricted use of designated pharmacies, and the impact of specialty drug classifications on healthcare costs, patient access, and quality of care. Participants also discussed the necessity of medical management and patient support services for complex or specialty drug therapies.

The hearing focused on reviewing rate increase requests from multiple insurance carriers regarding individual long-term care insurance policies. Key discussions involved the justification for these rate increases, which carriers attributed to industry-wide challenges such as rising morbidity and longevity, as well as lower-than-anticipated lapse rates and interest rate returns. The Administration reviewed the proposed increases for Continental Casualty Company and initiated discussions for Massachusetts Mutual Life Insurance Company, while also addressing policyholder concerns and available options, including reduced benefit plans and contingent non-forfeiture options.

The Maryland Insurance Administration held a public hearing to review rate increase requests for long-term care insurance policies issued by Continental Casualty Company and Lincoln Benefit Life Company. Key discussion topics included the justifications for the requested rate hikes, which were based on projected lifetime loss ratios, actuarial assumptions, and the impact on Maryland policyholders. The meeting addressed concerns regarding the magnitude of the requested increases, the methodology used to calculate them, and the options available to policyholders to mitigate the impact, such as benefit reductions or conversion to paid-up status.

The meeting provided extensive legislative updates impacting form filings and health insurance coverage. Topics included new guarantee issue rights for Medicare supplement policies, enhanced consumer protections for provider network changes, mandated benefits for perinatal behavioral health, vaccination and preventive care coverage requirements, and reimbursement for graduate level clinical interns. Additionally, discussions covered new mandates for scalp cooling systems and management of menopause-related symptoms, as well as modifications to the assignment of benefits requirements for dentists.