PROPOSED RULEMAKING
PENNSYLVANIA
HEALTH INSURANCE
EXCHANGE AUTHORITY
[ 31 PA. CODE CH. 5001 ]
Health Equity Accreditation
[54 Pa.B. 2993]
[Saturday, May 25, 2024]The Pennsylvania Health Insurance Exchange Authority d/b/a Pennie® (Exchange Authority) proposes to add Chapter 5001 to the Exchange Authority's regulations under Part L1 to read as set forth in Annex A. This rulemaking is proposed under the Exchange Authority's general rulemaking authority under section 506 of The Administrative Code of 1929 (71 P.S. § 186) and the act of July 2, 2019 (P.L. 294, No. 42) (Act 42 of 2019) which added 40 Pa.C.S. §§ 9101—9703 (relating to health insurance markets oversight), also known as the Health Insurance Markets Oversight Act, specifically 40 Pa.C.S. § 9701(a) (relating to regulations).
Background Information
The Exchange Authority is the State-affiliated entity that operates the Commonwealth's State-based health insurance marketplace. The Exchange Authority was created in July of 2019 under Act 42 of 2019. It was a unanimous and bipartisan effort to transition away from the Federal health exchange and to take State control by establishing a State-based health insurance marketplace at a significantly lower cost and using the savings to launch a reinsurance program to lower premiums for families purchasing health and dental insurance through the Exchange Authority. The Exchange Authority's mission is to improve the accessibility and affordability of individual market health coverage for all residents of this Commonwealth.
Purpose
The purpose of this proposed rulemaking is to require insurers selling qualified plans2 through the Exchange Authority to be accredited in health equity.3 Through health equity accreditation (HEA), insurers and their employees will learn about cultural competency within the healthcare field to ensure that every person—regardless of personal characteristics such as gender, race, socioeconomic status and geographical location—receives the same quality of care.
In recent years, health equity has become an important and well-recognized accreditation standard in the healthcare industry. Currently, multiple states and health plans across the country use HEA to identify and close significant health coverage and care gaps that remain in this country. Health equity plays a key role in the advancement of public health, particularly for historically underserved communities that may have inequitable access to critical healthcare services and that also experience worse long-term health outcomes than the general population. Gaining HEA will lead to better health outcomes for historically marginalized communities by requiring insurers to use race and ethnicity data for quality measurement. In addition, this process will help insurers build a diverse staff, reduce biased behavior and improve decision-making among employees. This will ensure that all Exchange Authority customers have access to the culturally competent care they deserve.
By requiring HEA, the Exchange Authority expects a decrease in health inequities among Commonwealth residents who purchase qualified plans through the Exchange Authority and an increase in enrollment among underserved populations.
Explanation of Regulatory Requirements
Proposed § 5001.1 (relating to scope) explains the proposed regulation's applicability.
Proposed § 5001.2 (relating to purpose) explains the purpose of the proposed regulation, which is to ensure that insurers selling qualified plans through the Exchange Authority are certified in health equity.
Proposed § 5001.3 (relating to definitions) defines the words and terms in Chapter 5001.
Proposed § 5001.4 (relating to achieving health equity accreditation) establishes the requirements and timeline to comply with the proposed regulation.
Proposed § 5001.5 (relating to recognized health equity accreditation organizations) establishes the standards that an HEA organization4 must meet for the Exchange Authority to recognize them as an organization through which insurers selling plans through the Exchange Authority can obtain accreditation.
Proposed § 5001.6 (relating to penalties) establishes the penalties for the regulated community for failure to meet the requirements of this regulation.
External Comments
Prior to the drafting of the annex, the Exchange Authority engaged in significant stakeholder engagement efforts, including with all of the health insurers offering qualified plans through the Exchange Authority (Capital Blue Cross, Highmark, UPMC, Independence Blue Cross, Cigna, Oscar, PA Health & Wellness and Geisinger) as well as the dental insurers (BEST Life, Delta Dental, Dominion National, DSM, Educators and The Guardian). The Exchange Authority received feedback from insurers indicating that many were already in the process of exploring HEA since they have lines of business in states requiring this type of accreditation. At the time of the drafting of this proposed rulemaking, one insurer, Independence Blue Cross, has already achieved HEA. In addition, the Exchange Authority also met with health insurance agents and certified enrollment assisters who work with local organizations across this Commonwealth. The feedback offered by insurers, agents and assisters, aided the Exchange Authority in drafting the annex.
More importantly, the Exchange Authority's board, which is comprised of representatives of insurance companies, consumer advocacy groups and State agencies, has been involved from the beginning of this process and has provided comments and suggestions on the scope and implementation of this proposed rulemaking. Before submitting the regulatory package, the board reviewed a draft of the annex and provided feedback.
Affected parties
This proposed rulemaking will directly affect insurers offering qualified plans through the Exchange Authority: eight health insurers as of August 2023 (Capital Blue Cross, Highmark, UPMC, Independence Blue Cross,5 Cigna, Oscar, PA Health & Wellness and Geisinger) and six dental insurers (BEST Life, Delta Dental, Dominion National, DSM, Educators and The Guardian). It will also affect insurers who will offer qualified plans through the Exchange Authority in the future.
In addition, this proposed rulemaking will affect individuals currently enrolled in qualified plans through the Exchange Authority (as of March of 2023 approximately 371,516 individuals) by providing for better and more equitable healthcare.
HEA organizations are not regulated by this proposed rulemaking. Only HEA organizations that submit an application to the Exchange Authority to be recognized as HEA organizations are indirectly and minimally affected because they would need to submit documentation to the Exchange Authority to demonstrate they are properly qualified.
Fiscal Impact
State government. There will not be any fiscal impact to the Exchange Authority or any other Commonwealth agency due to this proposed rulemaking.
General public. This proposed rulemaking will have no fiscal impact upon the general public.
Political subdivisions. This proposed rulemaking will have no fiscal impact upon political subdivisions.
Private sector. This proposed rulemaking will have no fiscal impact upon the private sector, except for minimal impact to the regulated entities. The Exchange Authority estimates that each insurer selling qualified plans through the Exchange Authority will pay approximately $6,240 plus $0.06 per member fee every 3 years for accreditation.
Paperwork
There are no forms that insurers selling qualified plans through the Exchange Authority, the regulated community, are required to complete and submit due to this regulation. However, once these insurers obtain HEA, they must submit a copy of their accreditation certificate to the Exchange Authority.
Organizations intending to qualify as a recognized HEA organization by the Exchange Authority must submit documentation (see Appendix A, which was submitted to the Independent Regulatory Review Commission (IRRC) as part of the Proposed Regulation. Appendix is available at https://www.irrc.state.pa.us/regulations/RegSrchRslts.cfm?ID=3416. Select ''Download proposed regulation,'' scroll to Appendix A.) to the Exchange Authority to ensure that their accreditation program satisfies the requirements set forth in the proposed regulation.
The only additional paperwork that would be imposed on the Exchange Authority as a result of this proposed rulemaking would be related to the review of the documentation submitted by HEA organizations that intend to be recognized by the Exchange Authority under § 5001.5(b) of this proposed rulemaking. It is expected that this paperwork will be minimal.
Effect Date
This proposed rulemaking will become effective immediately upon final-form publication in the Pennsylvania Bulletin.
Sunset Date
The Exchange Authority will monitor the effectiveness of this regulation every other year. Therefore, no sunset date has been assigned.
Contact Person
Questions or comments regarding this proposed rulemaking may be addressed in writing to PennieRegulations@pennie.com or to Ana Paulina Gomez, Chief Counsel, Pennsylvania Health Insurance Exchange Authority, P.O. Box 536, Harrisburg, PA 17108, within 30 days of the publication of this proposed rulemaking in the Pennsylvania Bulletin.
Regulatory Review
Under Section 5(a) of the Regulatory Review Act (71 P.S. § 745.5(a)), on May 7, 2024, the Exchange Authority submitted a copy of this proposed rulemaking and a copy of a Regulatory Analysis Form to IRRC and to the chairperson of the Banking & Insurance Committee of the Senate and the chairperson of the Insurance Committee of the House of Representatives. A copy of this material is available to the public upon request.
Under section 5(g) of the Regulatory Review Act, IRRC may convey any comments, recommendations or objections to the proposed rulemaking within 30 days of the close of the public comment period. The comments, recommendations or objections must specify the regulatory review criteria in section 5.2 of the Regulatory Review Act (71 P.S. § 745.5b) which have not been met. The Regulatory Review Act specifies detailed procedures for review, prior to final delivery of the rulemaking, by the Exchange Authority, the General Assembly and the Governor.
DEVON TROLLEY,
Executive DirectorFiscal Note: 130-1. No fiscal impact; recommends adoption.
Annex A
TITLE 31. INSURANCE
PART L. PENNSYLVANIA HEALTH INSURANCE EXCHANGE AUTHORITY
CHAPTER 5001. HEALTH EQUITY ACCREDITATION (Editor's Note: Chapter 5001 is proposed to be added and is printed in regular type to enhance readability.)
Sec.
5001.1. Scope. 5001.2. Purpose. 5001.3. Definitions. 5001.4. Achieving health equity accreditation. 5001.5. Recognized health equity accreditation organizations. 5001.6. Penalties. § 5001.1. Scope.
This chapter applies to insurers selling qualified plans through the Exchange Authority.
§ 5001.2. Purpose.
The purpose of this chapter is to increase health equity and enhance the cultural competency of healthcare services provided in this Commonwealth by requiring insurers selling qualified plans through the Exchange Authority to be accredited in health equity by a recognized accrediting body.
§ 5001.3. Definitions.
(a) The definitions in 40 Pa.C.S. § 9103 (relating to definitions) are incorporated by reference and apply to this chapter.
(b) The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
Department—The Insurance Department of the Commonwealth.
Exchange Authority—The Pennsylvania Health Insurance Exchange Authority d/b/a Pennie®.
Health equity—The fair and just opportunity for all individuals to attain their optimal health regardless of race, ethnicity, disability, sexual orientation, gender, socioeconomic status, geography, preferred language or other factors that affect access to care and health outcomes.
Recognized health equity accreditation organization—An organization recognized by the Exchange Authority to be qualified to offer health equity accreditation under § 5001.5 (relating to recognized health equity accreditation organizations).
§ 5001.4. Achieving health equity accreditation.
(a) Compliance. An insurer offering qualified plans through the Exchange Authority shall be accredited in health equity by a recognized health equity accreditation organization.
(b) Timeframe to achieve health equity accreditation.
(1) An insurer offering qualified plans through the Exchange Authority on ______ (Editor's Note: The blank refers to the effective date of the rulemaking.) shall achieve health equity accreditation by a recognized health equity accreditation organization by the start of the plan year that begins after ______ . (Editor's Note: The blank refers to the date 12 months after the effective date of the rulemaking.)
(2) An insurer seeking to offer qualified plans through the Exchange Authority shall achieve health equity accreditation by a recognized health equity accreditation organization by the start of the plan year immediately following the plan year in which the insurer is first certified to offer qualified plans through the Exchange Authority.
(3) Notwithstanding paragraphs (1) and (2), an insurer that has not attained accreditation within the time frame under paragraph (1) or paragraph (2), as applicable, may offer qualified plans through the Exchange Authority at the Exchange Authority's discretion if the insurer submits to the Exchange Authority a plan demonstrating its good faith and timely efforts to achieve health equity accreditation, including a date by which the insurer anticipates attaining accreditation.
(c) Annual submission. An insurer offering qualified plans through the Exchange Authority that achieves health equity accreditation as required under subsection (b) shall thereafter submit to the Exchange Authority a copy of its current health equity accreditation certificate by August 31 of every year by e-mail to PennieRegulations@pennie.com using the subject title ''Insurer Health Equity Accreditation Certificate.''
§ 5001.5. Recognized health equity accreditation organizations.
(a) Process for recognizing health equity accreditation organizations.
(1) An organization that seeks to qualify as a recognized health equity accreditation organization shall submit an application to the Exchange Authority to establish that its health equity accreditation program satisfies the requirements under subsection (b).
(2) The organization shall submit its application to the Exchange Authority in a form and manner approved by the Exchange Authority.
(3) The Exchange Authority shall review an organization's application for compliance with the requirements under subsection (b).
(4) The Exchange Authority may decline to approve or terminate the approval of an organization that does not satisfactorily comply with the requirements under subsection (b).
(5) If the Exchange Authority approves an organization's application, the organization shall do one of the following on an annual basis from the date its application was approved:
(i) Submit a letter to the Exchange Authority attesting that its program has not changed and continues to meet the requirements under subsection (b).
(ii) Submit a new application to the Exchange Authority if its program has changed.
(6) If the Exchange Authority approves an organization's application, the Exchange Authority will publish on its web site the organization's name in a list of recognized health equity accreditation organizations.
(b) Recognized health equity accreditation organizations requirements. To be recognized as a health equity accreditation organization by the Exchange Authority, an organization shall have a health equity accreditation program in the United States that:
(1) Educates an applicant seeking accreditation about health equity to help the applicant achieve a framework that advances health equity, expands coverage and improves health outcomes for the applicant's customers regardless of their race, ethnicity, disability, sexual orientation, gender, socioeconomic status, geography or preferred language.
(2) Is conducted in accordance with a written plan and curriculum or manual.
(3) Includes, at a minimum, curriculum that covers all of the following topics:
(i) Diversity of the workforce of the applicant seeking accreditation.
(ii) Access and availability of language services.
(iii) Cultural awareness and responsiveness.
(iv) Reduction of healthcare disparities.
(4) Has instructors and administrators with education or certification in health equity education.
(5) Has specific parameters that the applicant seeking accreditation must meet prior to becoming accredited in health equity.
(6) Has renewal criteria.
(7) Includes a health equity accreditation certification that expires in no more than 3 years if renewal criteria are not satisfied.
§ 5001.6. Penalties.
Failure to comply with the provisions of this chapter will subject an insurer offering qualified plans through the Exchange Authority to referral to the Department for enforcement in accordance with 40 Pa.C.S. § 9702 (relating to enforcement) and any other penalty provided by law.
[Pa.B. Doc. No. 24-752. Filed for public inspection May 24, 2024, 9:00 a.m.] _______
1 Currently, the Exchange Authority does not have any regulations. The proposed HEA regulation would be the Exchange Authority's first regulation. This, and future regulations, will be codified in 31 Pa. Code Part L. The first chapter of the Exchange Authority's regulations will begin with Chapter 5001.
2 A qualified plan is a health or dental insurance policy offered by a qualified insurer in a state-based or Federally-facilitated health insurance marketplace. Qualified Plans are defined in 40 Pa.C.S. § 9103 (relating to definitions).
3 The proposed regulation's definition of ''health equity'' is based on the Centers for Medicare & Medicaid Services' definition of health equity but slightly reworded for clarity purposes only.
4 Interested HEA organizations will need to submit documentation about their health equity certification program to the Exchange Authority for review to ensure that their programs properly cover all the standards set forth in § 5001.5(b) of this proposed rulemaking. If their program meets the standards, the Exchange Authority will list their names on its web site. Insurers can then select an organization from that list to obtain accreditation.
5 Independence Blue Cross has already received HEA.
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