The Ticker

Gov. Jay Inslee signs law creating first-in-nation long-term care program. Benefits of up to $36,500 per person begin Jan. 1, 2025, for those paying in. Program to be funded by 0.58% employee payroll tax starting in 2022. Eligibility requires paying the premium while working for at least 500 hours per year for three of the six years prior to date they seek LTC benefits or paying in for a total of 10 years, with five or more of those years uninterrupted. Private insurers could offer products to supplement the state coverage. 

Nixes association health plans beginning in 2020. >> Gov. Phil Scott signed S 131 into law, creating a regulatory sandbox that allows the commissioner of financial regulation to grant waivers that exempt innovators from statutory and regulatory requirements for a limited period of time. A company must demonstrate the waiver is in the public interest and won’t substantially increase consumer risk. The Department of Financial Regulation could find, after successful product or service development under a waiver, that law or regs should be changed so innovation could be offered on permanent basis. Expects to begin accepting applications for waivers late this year. 

Former commissioner of insurance Julie McPeak has joined Greenberg Traurig’s insurance regulatory and transactions practice and will help open the law firm’s Nashville office. Prior to heading Tennessee’s Department of Insurance, McPeak was counsel to law firm Burr & Forman’s insurance practice. She is also immediate past-president of the National Association of Insurance Commissioners. Carter Lawrence, previously deputy commissioner for administration, serving as interim commissioner.

SB 507, signed into law June 13, gives coverage for PTSD as an occupational disease to full-time firefighters and policemen as well as corrections, parole and probation officers and first responders who have served at least five years and have suffered a traumatic event. 

Ohio Bureau of Workers Compensation ends coverage for new prescriptions of OxyContin and generic forms. Patients already taking the drugs have until Dec. 31 to switch to a product on the state’s workers comp formulary. >> BWC earned 5.1% on invested assets allowing for about $1.5 billion in returned premiums—88% of what was paid for policy year ending June 30, 2018—to employers participating in the workers comp system.

Department of Financial Services creates cyber-security division, first state to do so. Justin Herring named executive deputy superintendent in charge of division. He was chief of cyber crimes unit at U.S. Attorney’s Office in New Jersey. >> State Workers Compensation Board formally adopts drug formulary, effective Jan. 5. It sets requirements for prescribing drug and mandates drug reviews for “special consideration” drugs, notably controlled substances, for which scripts may not exceed seven-day supply on first fill. Preauthorization needed for all drugs in the “special” category as well as brand-name drugs, compound drugs and any medications not listed on the formulary. Insurers and self-insured business must have two preauthorization tiers. First review goes to payer. Second sent to medical professional if prescribing physician objects to first review’s decision. Insurers and self-insured employers have six months to identify injured workers currently prescribed drugs not listed in the formulary and notify in writing the claimant and the prescribing doctor of the preauthorization rules—including fact that payers can deny payment for drugs that aren’t preauthorized.