New Georgetown Report on State Approaches to Protecting Consumers from the Unexpected Charges of Balance Billing

Implementing the ACA

A new report from Georgetown University researchers examines the phenomenon of surprise bills for out-of-network medical services, often called “balance billing.” These unexpected charges can often be significant and cause great stress for patients. Several states have implemented consumer protections, but they take different approaches with varying effectiveness. Jack Hoadley provides the highlights. Continue reading

Not One, Not Two but Three New Resources from CHIR: Small Business Health Plans in a Post-ACA World

Implementing the ACA

There’s been some renewed attention to the status and future of the small business health insurance market, particularly as an Affordable Care Act reform scheduled to go into effect in 2016 could cause some disruption. Last week CHIR researchers contributed to three great new resources to help policymakers and others understand changes in the market and some of the challenges ahead. Continue reading

State Decisions on Allowing Mid-Sized Employers to Delay a Move to the Small-Group Insurance Market

State of the States

Beginning in 2016, the Affordable Care Act requires states to change the definition of “small employer” from one with up to 50 employees to up to 100 employees. Such a change could affect health insurance coverage and prices for small businesses and their workers. However, many states are taking advantage of a transition period offered by the Obama Administration that would delay this change. Ashley Williams and Sabrina Corlette, in their latest blog post for the Commonwealth Fund, report on the results of a 50-state survey and the implications for the small group insurance market. Continue reading

Telemedicine and its Effect on the Regulatory Landscape

Implementing the ACA

Some states are making policies related to the emergence of telemedicine or the delivery of health care services through telecommunication technology. While states are taking varying approaches, telemedicine can increase access to specialty services such as mental health services and help address network adequacy concerns. CHIR’s Sandy Ahn highlights some of the issues related to telemedicine. Continue reading

New Proposed Rules for Network Adequacy for Medicaid Managed Care Plans – Lessons Learned from Medicare & the Marketplaces

Implementing the ACA

The Centers for Medicare and Medicaid Services (CMS) recently released draft regulations governing Medicaid managed care plans. In setting standards for network adequacy, the agency looked to both the Medicare Advantage program and the health insurance marketplaces created under the Affordable Care Act. Sabrina Corlette examines approaches to ensuring adequate plan networks across the three programs. Continue reading

New Guidance Clarifying Preventive Services under the Affordable Care Act

Implementing the ACA

The Affordable Care Act requires most health plans to cover preventive services without cost sharing and enables consumers to access evidence-based medical care such as cancer screenings and immunizations for children. Implementation of this requirement, however, has raised questions and caused confusion among insurers, providers and consumers. Sandy Ahn reviews the Administration’s most recent guidance on this critical ACA provision, designed to clarify for insurers what they must do to comply and ensure that consumers receive the benefits they are promised under the law. Continue reading