1     
INSURANCE NETWORK STUDY

2     
2020 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Suzanne Harrison

5     
Senate Sponsor: ____________

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7     LONG TITLE
8     General Description:
9          This bill amends the Insurance Code regarding the duties of the insurance
10     commissioner.
11     Highlighted Provisions:
12          This bill:
13          ▸     requires the insurance commissioner to conduct an evaluation regarding the health
14     benefit plan market and report findings to the Business and Labor Interim
15     Committee; and
16          ▸     makes technical and conforming changes.
17     Money Appropriated in this Bill:
18          None
19     Other Special Clauses:
20          None
21     Utah Code Sections Affected:
22     AMENDS:
23          31A-2-201.2, as last amended by Laws of Utah 2019, Chapters 241, 241, and 439
24     

25     Be it enacted by the Legislature of the state of Utah:
26          Section 1. Section 31A-2-201.2 is amended to read:
27          31A-2-201.2. Evaluation of health insurance market.
28          (1) Each year the commissioner shall:
29          (a) conduct an evaluation of the state's health insurance market;
30          (b) report the findings of the evaluation to the Health and Human Services Interim
31     Committee before December 1 of each year; and
32          (c) publish the findings of the evaluation on the department website.
33          (2) The evaluation required by [this section] Subsection (1) shall:
34          (a) analyze the effectiveness of the insurance regulations and statutes in promoting a
35     healthy, competitive health insurance market that meets the needs of the state, and includes an
36     analysis of:
37          (i) the availability and marketing of individual and group products;
38          (ii) rate changes;
39          (iii) coverage and demographic changes;
40          (iv) benefit trends;
41          (v) market share changes; and
42          (vi) accessibility;
43          (b) assess complaint ratios and trends within the health insurance market, which
44     assessment shall include complaint data from the Office of Consumer Health Assistance within
45     the department;
46          (c) contain recommendations for action to improve the overall effectiveness of the
47     health insurance market, administrative rules, and statutes;
48          (d) include claims loss ratio data for each health insurance company doing business in
49     the state[.];
50          (e) include information about pharmacy benefit managers collected under Section
51     31A-46-301; and
52          (f) include information, for each health insurance company doing business in the state,
53     regarding:
54          (i) preauthorization determinations; and
55          (ii) adverse benefit determinations.
56          (3) The commissioner shall:
57          (a) conduct an evaluation of the adequacy of insurer networks in the health benefit plan
58     market for the 2020 plan year; and
59          (b) before December 1, 2021, report the findings of the evaluation described in
60     Subsection (3)(a) to the Business and Labor Interim Committee.
61          [(3)] (4) When preparing [the] an evaluation and report required by this section, the
62     commissioner may seek the input of insurers, employers, insured persons, providers, and others
63     with an interest in the health insurance market.
64          [(4)] (5) The commissioner may adopt administrative rules for the purpose of
65     collecting the data required by this section, taking into account the business confidentiality of
66     the insurers.
67          [(5)] (6) Records submitted to the commissioner under this section shall be maintained
68     by the commissioner as protected records under Title 63G, Chapter 2, Government Records
69     Access and Management Act.