Implementation of SS1 to SB 120 for Plan Year 2022 – Achieving Affordability Standards

TRINIDAD NAVARRO COMMISSIONER STATE OF DELAWARE DEPARTMENT OF INSURANCE TO: RE: DOMESTIC & FOREIGN INSURERS BULLETIN NO. 125 ALL DOMESTIC AND FOREIGN INSURERS WRITING HEALTH INSURANCE IN DELA WARE IMPLEMENTATION OF SSl TO SB 120 FOR PLAN YEAR 2022 - ACHIEVING AFFORDABILITY STANDARDS DATED: October 13, 2021 The purpose of this bulletin is to inform health care carriers that the Governor signed SS 1 for SB 120, which relates to primary care services (hereinafter "the Bill"), on October 1, 2021, and to inform health care carriers of the Department's implementation plan. Relevant sections of the Bill are also summarized below. I. Implementation Plan Each health care carrier should begin to: • Make progress toward achieving the newly promulgated affordability standards beginning with plan year 2022, including using the rate review template documents on which they have been trained by the Department's Office of Value Based Health Care Delivery (OVBHCD); • Identify internal programs in Delaware or throughout their national enterprise that could support the carrier in achieving the Bill's primary care investment requirements at 18 Del.C §§2503(a)(14) and alternative payment model requirements at 3342B(b)(3) and 3556A(b)(3); and • Identify and adjust contracts with health systems to support compliance with the unit price growth requirements at 18 Del.C §2503(a)(12)a. Note that Carriers are expected to be in compliance with the Bill's unit price and primary care spending requirements for Plan Year 2023 and thus are encouraged to make progress expeditiously. NOTE: This Bulletin is intended solely for informational purposes. It is not intended to set forth legal rights, duties, or privileges, nor is it intended to provide legal advice. Readers should consult applicable statutes and rules and contact the Delaware Department of Insurance if additional information is needed. + INSURANCE.DELAWARE.GOV+ 1351 W. NORTH ST., SUITE 101, DOVER, DELAWARE 19904-2465 (302) 674-7300 DOVER+ (302) 259-7554 GEORGETOWN+ (302) 577-5280 WILMINGTON Questions concerning this Bulletin should be emailed to: DOL-Legal@delaware.gov. This Bulletin shall be effective immediately and shall remain in effect unless withdrawn or superseded by subsequent law, regulations, or bulletin. Trinidad Navarro Delaware Insurance Commissioner 'The Core CPI referenced in 18 Del.C. § 2503(a)(12) will be based on the average Core CPI over a defined period of time, also known as a lookback period. The OVBHCD has modeled a Core CPI based three possible lookback periods: previous calendar year, a rolling previous 12 months and a rolling 36 months. The Core CPI including the lookback period will be further defined in regulation. ii 16 Del. C. 9903 requires the Health Care Commission, in collaboration with the Primary Care Reform Collaborative, to design a Delaware Primary Care Model that: (1) helps primary care providers "achieve targets for value-based care through increased participation in alternative payment models that are not paid on a fee for service or per claim basis and include quality and performance improvement requirements" and (2) rewards primary care services that are designed to reduce health disparities and address social determinants of health. 3