November 30, 2022

To: All insurers authorized to write accident and health insurance in New York State, Article 43 corporations, health maintenance organizations, student health plans certified pursuant to Insurance Law § 1124, and prepaid health services plans, offering fully insured commercial comprehensive health insurance.

Re: Health Equity Programming and Collection of Race, Ethnicity, and Other Demographic Data

Health disparities^[1] impact many regions and communities in New York. These health disparities, often in health care access, affordability, and equity, have been exacerbated by the COVID-19 pandemic.  Many health insurers in New York State already have programs or initiatives which aim to reduce the impact of health disparities, develop solutions that directly address such disparities, and/or promote more equitable health outcomes for New Yorkers (hereinafter described as “health equity programs”). In an effort to understand the extent of those activities and initiatives, and more importantly, to support such health equity programs, the New York State Department of Financial Services (the “Department” or “DFS”) is hereby requesting information and documentation on race/ethnicity and language data collection efforts, health equity programs, and workforce initiatives developed by insurers authorized to write accident and health insurance in New York State, Article 43 corporations, health maintenance organizations, student health plans certified pursuant to Insurance Law § 1124, and prepaid health services plans, offering fully insured commercial comprehensive health insurance.

Pursuant to Section 308 of the New York Insurance Law, DFS hereby directs you to respond on behalf of [COMPANY NAME] (“Company”) to the following requests for information and documentation relating to health equity programming and race/ethnicity and language data collection and usage. Do not include programs that are limited to Medicaid and/or Medicare.

A. Health Equity Programs

1. Does the Company have any program(s) (including all efforts or initiatives of varying duration and size) developed to specifically address health disparities or designed to advance health equity?
   1. Include the reason(s) for adopting the program(s) and the intended goals of the program(s).
   2. Indicate how the Company defines any “health disparities” that it has identified (e.g., based on race, ethnicity, language, access, geography, serious mental illness, substance use disorder, etc.).
   3. Indicate whether the definition for “health disparities” differs for each line of business to which it is applied.
   4. Describe the health disparities identified by the Company by line of business, and describe the method used by the Company to identify populations or communities where health disparities may exist.
2. Has the Company employed any individual(s) to oversee its health equity program(s) and its(their) implementation? If so, please provide the contact information for such individual(s) (e.g., name, title, email address, and phone number).
3. Describe in detail all programs the Company has developed to address health disparities, including, but not limited to, those programs developed to address disparities in the following areas: infant mortality, maternal mortality, pediatric asthma, diabetes, hypertension, breast cancer, colon cancer, adult and child vaccinations, utilization of dental care, utilization of mental health care for those with mental illness, and utilization of substance use services. In addition, you may include any internal workforce activities or investments, programs for provider cultural competency, or diversity equity and inclusion training of providers.
   1. Describe, if any, benefit design modifications the Company has piloted or adopted in order to reduce health disparities.
   2. Describe in detail the Company’s methodology to monitor and evaluate the impact and effectiveness of its health equity programs.
   3. Describe any of the Company’s health equity programs that have been successful in minimizing disparities. Please provide duration and relevant metrics.
   4. Describe, if any, community-based activities or programs (e.g., with a provider or community center) the Company has partnered with to address health disparities.
   5. Indicate the (1) annual current and/or budgeted expenses (operating or SG&A expenses only) by the Company toward health equity programs, and (2) proportion of total annual current and/or budgeted health equity expenses (operating or SG&A expenses only) to the Company's total annual current and/or budgeted expenses (operating or SG&A expenses only).
   6. If possible, indicate the (1) annual current and/or budgeted expenses (operating or SG&A expenses only) by the Company allocated to specific communities/regions served by health equity programs, and (2) proportion of total annual current and/or budgeted health equity expenses allocated to specific communities/regions served by health equity programs (operating or SG&A expenses only) to the Company's total annual current and/or budgeted expenses (operating or SG&A expenses only).
4. Has the Company entered into any arrangement with a health care provider entity (hospital, health system, accountable care organization, IPA, FQHC, community health center, community-based organization, or other provider) through which the Company incentivizes such health-providing entity to address health disparities or cultural competency in health care? Please describe such arrangement(s) in detail.
   1. Describe, if at all, how the Company incorporates any health equity measures into any pay-for-performance or value-based payment initiatives.
   2. Describe any incentives (financial or otherwise) the Company has for providers working in underserved communities.
5. Has the Company achieved any kind of health equity accreditation for any of its lines of business (including any NCQA accreditation such as the health plan accreditation, health equity accreditation, health equity accreditation plus)? If so, identify which lines of business have achieved such accreditation, and their corresponding accrediting entity (e.g., NCQA).
6. Does the Company use health equity and/or cultural competency metrics and/or data in its determination of network adequacy? Does the Company require or collect health equity and/or cultural competency data in connection with any arrangement or contract with health care providers?

B. Race, Ethnicity and Language Data

1. Does the Company collect race, ethnicity, gender identity, cultural and/or language data? If so, describe the source of the data (e.g., direct from plan member, from provider, or elsewhere), and the method for collection of such data.
   1. Describe the type of analysis, if any, that the Company uses to assess the race, ethnicity, gender identity, cultural and language data that the Company collects.
   2. If the Company does not collect such data, describe the methodology or statistical analysis, if any, that the Company uses to assess the race, ethnicity, gender identity, culture and language of policyholders/plan members
   3. Does the Company collect data that can be disaggregated by race, ethnicity, gender identity, culture, and language on any of the following dimensions: infant mortality, maternal mortality, pediatric asthma, diabetes, hypertension, breast cancer, colon cancer, adult and child vaccinations, utilization of dental care, and utilization of mental health care for those with mental illness and utilization of substance use services? On any other dimensions?
2. Does the Company’s method(s) for assessing plan-member race and/or ethnicity data include best practices for collection and use? If so, describe the best practice standards (including any federal or state standards) applied to the collection and use of race and/or ethnicity data and the source of those standards.
3. Does the Company’s method(s) for assessing plan-members’ language needs include best practices for collection and use of such information? If so, describe the best practice standards (including any federal or state standards) applied to collection and use of language data, and the source of those standards.
4. Describe any quality standards the Company applies for the race, ethnicity, gender identity, cultural and language data it collects.
5. Describe the extent to which race, ethnicity, gender identity, cultural and language data is used in connection with health equity programs.
6. Describe the extent to which race, ethnicity, gender identity, cultural and language data is used in connection with other programs unrelated to health equity.
7. Describe how the Company uses race and/or ethnicity data to monitor and assess healthcare services covered under its health plan(s), if at all.
8. Describe how the Company uses gender identity data to monitor and assess healthcare services covered under its health plan(s), if at all.
9. Describe how the Company uses cultural data to monitor and assess healthcare services covered under its health plan(s), if at all.
10. Describe how the Company uses language data to monitor and assess healthcare services covered under its health plan(s), if at all.
11. Describe how the Company uses race, ethnicity, gender identity, cultural and language data to monitor, assess and reduce biased behavior among its network providers, if at all.
12. Describe any barriers or challenges, including legal or regulatory, to the collection and use of race, ethnicity, gender identity, cultural and language data. Include what intended action(s) or information such barrier and/or challenge prevents, and any efforts to overcome them.

Your response should be submitted in writing within thirty (30) business days of your receipt of this letter and must be subscribed to and affirmed by an officer of the Companies as true under the penalties of perjury.  If you fail to make a good faith response within thirty (30) business days, then the Department is authorized by law to levy a civil penalty.  Please direct the Companies’ response to [email protected] or to:

Department of Financial Services

Insurance Division, Health Bureau

ATTN: Joel Dankwa

One State Street, 11th Floor

New York, NY  10004

If you have any questions, please contact Joel Dankwa, Assistant Counsel at (212) 480-7709 or [email protected].

 

Very truly yours,

 

Lisette Johnson

 

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