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PA Bulletin, Doc. No. 23-1709

NOTICES

INSURANCE DEPARTMENT

Guidance for Act 146 of 2022 Compliance Filings; Notice 2023-18

[53 Pa.B. 7686]
[Saturday, December 9, 2023]

 On November 3, 2022, former Governor Tom Wolf signed into law the act of November 3, 2022, (Pub.L. 2068, No. 146) (Act 146), which amends the act of May 17, 1921, (Pub.L. 682, No. 284) by substantially increasing the Insurance Department's (Department) oversight related to, inter alia, the Commonwealth's commercial health insurance prior authorization and appeal processes. As part of these processes, health insurers must develop and use certain forms prescribed by Act 146. A collaborative development process has been occurring between the Department and health insurers throughout the fall months. Act 146 takes effect on January 1, 2024.

 The act of December 22, 2011, (Pub.L. 614, No. 134) (Act 134) requires each insurer to file with the Department any form which it proposes to issue in this Commonwealth no less than 45 days prior to its effective date.1 Many form filings for qualified health plans that will be subject to Act 146's requirements were reviewed and dispositioned during the summer and fall months preceding the new plan year in accordance with Federal timelines. Thus, individual and small group forms for Plan Year 2024, beginning on January 1, were already finalized prior to the development of the Act 146 forms. Additionally, certain group forms that may start or be renewed mid-year have already been reviewed.

 Through this notice, the Department is providing the regulated community notice that it will exercise enforcement discretion for forms required by Act 146 that will be used beginning on January 1, 2024, but that have not yet been filed for approval in accordance with Act 134 requirements. Note that this enforcement discretion only extends to the Act 134 form filing requirements for Act 146 forms to be used during Plan Year 2024; the Department expects that Act 146 forms used during Plan Year 2024 will comply with all relevant Act 146 requirements. Moreover, the Department expects the regulated community to operationalize the processes required by Act 146 in accordance with the statutory timeframes.

 Questions regarding this notice may be directed to Robert Feguer, Director, Bureau of Managed Care, Insurance Department, 1311 Strawberry Square, Harrisburg, PA 17120, ra-inburmngdcareprdr@pa.gov.

MICHAEL HUMPHREYS, 
Insurance Commissioner

[Pa.B. Doc. No. 23-1709. Filed for public inspection December 8, 2023, 9:00 a.m.]

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1  The Commissioner has identified certain forms that are exempt from filing in Department Notice 2018-10, 48 Pa.B. 7282 (November 17, 2018). Neither Act 146 nor this notice alters the guidance provided in Notice 2018-10.


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