NCOIL Adopts Three New Health Model Laws During Annual Meeting in Scottsdale

For Immediate Release
November 30, 2021
Contact: Emme Anderson
(732) 201-4133

Model Laws Include NCOIL Telemedicine Authorization and Reimbursement Model Act; NCOIL Accumulator Adjustment Program Model Act; and NCOIL Model Act Regarding Air Ambulance Patient Protections

Manasquan, NJ: – During the recently concluded 2021 National Council of Insurance Legislators (NCOIL) Annual National Meeting in Scottsdale, AZ, NCOIL, the nation’s premier legislator-led insurance public policy organization, adopted three new NCOIL Model Laws. The Models were first passed via voice vote by the group’s Health Insurance and Long-Term Care Issues Committee (Committee), Chaired by NY Asw. Pam Hunter, then adopted without dissent by the NCOIL Executive Committee.

The three new Model Laws are: the NCOIL Telemedicine Authorization and Reimbursement Model Act, sponsored by Asw. Hunter; the NCOIL Accumulator Adjustment Program Model Act, sponsored by AR Sen. Jason Rapert, NCOIL Immediate Past President, and co-sponsored by AR Rep. Deborah Ferguson, new NCOIL Secretary and Vice Chair of the Committee, ND Rep. George Keiser, former NCOIL President, and Asw. Hunter; and the NCOIL Model Act Regarding Air Ambulance Patient Protections, sponsored by WV Del. Steve Westfall and co-sponsored by IL Rep. Thaddeus Jones, KY Rep. Deanna Frazier, and TX Rep. Tom Oliverson, M.D., new NCOIL Treasurer.

Asw. Hunter stated “this Committee has worked very hard throughout the past year to make sure these Models were improved in response to the significant feedback received from the wide array of interested parties that were involved in this process. None of the Models adopted received unanimous Committee support, and that’s ok. As we all know from our work in our respective state legislatures – everyone is not going to agree on everything, but it’s important to always maintain a healthy and respective exchange of ideas when it comes to insurance public policy issues.” Hunter continued “and of course, consistent with NCOIL’s philosophy on model laws, states aren’t bound by the provisions in our models. Rather, they are intended to serve as a framework so that states can add or remove things if desired.”

“During my last meeting as NCOIL President, it was great to see the Committee take action on such important issues,” said IN Representative and outgoing NCOIL President Matt Lehman. “I was very pleased to see the Committee be so productive, and I look forward to participating in the
Committee’s great work going forward.”

The NCOIL Telemedicine Authorization and Reimbursement Act (TARA) encourages health insurers and health care providers to support the use of telemedicine, and also encourages state agencies to evaluate and amend their policies and rules to remove any regulatory barriers prohibiting the use of telemedicine services. Having been introduced during the height of the COVID-19 pandemic, TARA is an acknowledgement that access to telemedicine is vital to ensuring the continuity of physical, mental, and behavioral healthcare for consumers during the pandemic and responding to any future outbreaks of the virus.

Two issues in TARA that garnered significant attention were reimbursement levels for telemedicine services, and using telemedicine to satisfy network adequacy requirements. Ultimately, the Committee approved language in TARA that permits health insurers and healthcare providers to negotiate reimbursement levels, and permits health insurers to use telemedicine to satisfy network adequacy requirements with regard to healthcare services, but not exclusively.

Asw. Hunter said, “I am proud to have sponsored TARA as it deals with such an important issue. Telemedicine certainly didn’t start with the COVID-19 pandemic, but I think it showed us all that it definitely will be more frequently utilized in the years to come. It is vital that people have the proper access to telemedicine, as it is crucial to ensuring the continuity of physical, mental, and behavioral health care of consumers, especially during health emergencies such as the COVID-19 pandemic.”

“The level of discussion around ‘payment parity’ for telemedicine was perhaps unprecedented for any single phrase in a model law in my time at NCOIL,” stated NCOIL General Counsel Will Melofchik. “However, Chair Hunter stated repeatedly and unambiguously that the reimbursement language does not mean dollar-for-dollar payment equality.”

The NCOIL Accumulator Adjustment Program Model Act (Accumulator Model) seeks to prohibit accumulator adjustment programs which prevent copayment assistance that helps patients pay for high-cost prescription drugs from counting towards their annual deductible or maximum out-of-pocket costs. The Accumulator Model, and the similar laws across the country, state that no matter who is contributing towards prescription drug costs, whether its pharmaceutical manufacturers, copay systems, a go fund me page, or aunt or uncle, those funds and third party payments should be counted towards a patient’s cost-sharing requirements.

“As legislators, we need to make sure that our constituents are being fairly treated by health insurers and are not receiving any unexpected charges,” said Arkansas Senator Jason Rapert, NCOIL Immediate Past President and Prime Sponsor of the Accumulator Model. “When patients are faced with unexpected charges, they are oftentimes less likely to adhere to their medical regimen, which can lead to various health consequences, such as unexpected visits to the emergency room. I sponsored a similar law in my home state of Arkansas and I am proud that NCOIL has now offered guidance to other states on this important issue.”

The NCOIL Model Act Regarding Air Ambulance Patient Protections (Air Ambulance Model), aims to amend state insurance laws to include certain air ambulance membership subscriptions as insurance products. The Air Ambulance Model also requires any entity operating such an air ambulance membership program to: implement a patient advocacy program that shall include, among other things, a dedicated patient hotline number and dedicated patient resource e-mail address to process patient billing and claims, and to address patient questions, complaints and concerns; and make other consumer disclosures on any advertisement, marketing material, brochure or contract terms and conditions made available to prospective members or the public, including noting that if eligible and covered by Medicaid or Medicaid managed care, the prospective member is already covered with no out of pocket cost liability for air ambulance services.

West Virginia Delegate Steve Westfall, Prime Sponsor of the Air Ambulance Model said, “It is important that products acting as insurance are categorized and regulated as such so that the proper consumer protections are in place. The old saying ‘If it walks like a duck and quacks like a duck…’ rings true with air ambulance membership subscriptions. I sponsored similar legislation in my home state of West Virginia and I am confident that states will look to this tightly crafted NCOIL Model and take action.” Westfall continued “The legal challenges surrounding these types of laws are well known, but I believe the NCOIL Model has been drafted in such a way that affirms the ability of states to regulate the business of insurance without threat of Federal obstruction.”

“Kudos to Chair Hunter, the sponsors, and everyone else involved, for the successful passage of three significant NCOIL Model Laws,” said Commissioner Tom Considine, NCOIL CEO. “These issues have clearly struck a chord with the Committee and interested parties given the level of rigorous debate these Models have had over the past several months. It is encouraging to see how much time and effort goes into the passage of our Model Laws – in these cases over many meetings of vigorous discussion – it shows how much people care which is one of the many reasons why NCOIL is such a great organization.”


NCOIL is a national legislative organization with the nation’s 50 states as members, represented principally by legislators serving on their states’ insurance and financial institutions committees. NCOIL writes Model Laws in insurance and financial services, works to preserve the State jurisdiction over insurance as established by the McCarran-Ferguson Act over seventy years ago, and to serve as an educational forum for public policymakers and interested parties. Founded in 1969, NCOIL works to assert the prerogative of legislators in making State policy when it comes to insurance and educate State legislators on current and longstanding insurance issues.