Two states recently enacted new pharmacy benefit manager licensing requirements that affect pharmacy benefit managers in Kentucky and New Mexico. It is important for Pharmacy Benefit Managers to ensure they are in compliance...more
Recently, two state insurance departments took action against third party administrators in their respective states based on their failure to be properly licensed. These regulatory actions demonstrate the importance for TPAs...more
Polsinelli is pleased to share the June 2016 Third Party Administrator Newsletter. This newsletter covers topics throughout the year that impact TPAs. Information specific to Polsinelli's TPA practice is also included....more
7/11/2016
/ Filing Requirements ,
Health Insurance ,
Insurance Industry ,
Insurance Regulations ,
Licensing Rules ,
Medicaid ,
NAIC ,
Plan Administrators ,
Policies and Procedures ,
Prescription Drugs ,
Proposed Legislation ,
Registration Requirement ,
Service Agreements ,
Third-Party Agents
The NAIC Model Third Party Administrator Act and almost every state that has enacted laws regulating TPAs require such agreements to comply with the following...more
The Audit and Enforcement Unit of the California Division of Workers’ Compensation (DWC) issued a press release recently indicating it will be conducting more target audits in 2016 to address utilization review (UR)...more
Legislation was recently introduced in the Washington State House of Representatives (HB 2445) and the Washington State Senate (SB 6447) that would require third party administrators to register with the Washington Office of...more
Polsinelli is pleased to share the December 2015 Third Party Administrator Newsletter. This newsletter covers topics throughout the year that effect TPAs.
Items discussed in this report include:
- State Insurance...more
Recently, two state insurance departments took action against third party administrators operating in their respective states based on their failure to be properly licensed as a TPA. These regulatory actions against...more
House Bill 64 recently amended Ohio Revised Code Chapter (ORC) 3959. The relevant code sections amended by House Bill 64 are ORC 3959.111 and ORC 3959.12 and these changes took effect on September 29, 2015.
Pursuant to...more
Missouri insurance regulators recently announced a $1.25 million settlement with nine affiliated insurance companies as a result of a market conduct examination into their handling of workers’ compensation insurance. ...more
The Missouri Department of Insurance, Financial Institutions and Professional Registration (DIFP) recently announced that it has entered into a $7.8 million regulatory settlement with Healthy Alliance Life Insurance Co. and...more
The Washington State Department of Health has promulgated a new rule clarifying the Department's authority to issue civil penalties against health carriers and third-party administrators. This rule, which is outside the...more
This past legislative session, several state legislatures enacted legislative regulating pharmacy benefit managers ("PBMs"). New Mexico, Utah, and Washington all adopted laws requiring licensure or registration of PBMs, in...more
On March 31, 2014, Benjamin M. Lawsky, Superintendent of the New York Department of Financial Services ("NYDFS") announced an Agreement under which MetLife will pay $60 million for insurance licensing violations by two of its...more
Our firm's Summer 2012 Insurance Business & Regulatory newsletter discussed a recent increase in market conduct examination activity by the Missouri Department of Insurance, Financial Institutions and Professional...more
In This Issue:
- Nevada Begins Audits of TPAs
- Insurers Challenge Requirement to Use Social Security Death Master File
- ACLI Files Lawsuit Regarding Prohibition on Offshoring
- Tennessee Modifies...more