Telemedicine: Another Tool in the Toolkit to Meet Network Adequacy Standards?

Health plans have been increasingly narrowing their provider networks, raising concerns about gaps in access to services for consumers, particularly in areas with provider shortages. Could telemedicine be used to help fill those gaps? CHIR authors say not yet and summarizes key findings from a new report published in partnership with the Urban Institute and with funding from the Robert Wood Johnson Foundation. Continue reading

Georgetown Experts Help States Weigh Solutions to Protect Consumers from Unexpected Medical Bills

As reports of patient encounters with unexpected provider bills continue to make headlines, state and federal policymakers are working to find solutions to the problem of surprise out-of-network billing. A recent Georgetown report on the issue caught the eye of two states – Pennsylvania and Florida – that are attempting to set new standards to protect consumers from balance bills. CHIR’s Ashley Williams shares a summary of what these states heard from our report’s lead authors. Continue reading

The NAIC’s Summer Meeting: Updating Network adequacy and ACA Transparency Requirements

The National Association of Insurance Commissioners (NAIC) has been hard at work updating a model state law governing the adequacy of health plan provider networks and revising the ACA-mandated summary of benefits of coverage for consumers. JoAnn Volk serves as a consumer representative to the NAIC and shares details from their recent national meeting as well as upcoming activities. Continue reading

Telemedicine and its Effect on the Regulatory Landscape

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

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 Georgetown Report: Assessing Consumers’ Experience with ACA Coverage through the Eyes of State Consumer Assistance Programs

While the ACA has successfully resulted in 16.4 million newly insured people, we don’t yet know a lot about how that new coverage is working for them. However, state consumer assistance programs (CAPs) have the eyes and ears on the ground to help identify problems or gaps in private insurance coverage. Georgetown researchers surveyed 10 state CAPs and found many common issues for consumers’ coverage experiences, pre- and post-ACA. Continue reading