Author Archive: CHIR Faculty
Providers Challenge Payments In ‘No Surprises’ Act Dispute Resolution Process

Under the No Surprises Act, consumers are held harmless beyond in-network cost sharing when they receive certain kinds of out-of-network care. In these scenarios, to determine the provider’s payment, payers and providers may enter independent dispute resolution (IDR). Recently, federal agencies released an initial report on the No Surprises Act’s IDR process. In a post for Health Affairs Forefront, CHIR experts Jack Hoadley and Kevin Lucia analyze the new report and discuss what it suggests about the No Surprises Act.
Coverage of Preventive Services Without Cost Sharing in Jeopardy as Texas Court Strikes Down ACA Protection

At the end of March, a federal judge in Texas partially invalidated one of the ACA’s most popular provisions—the requirement to cover a set of preventive services without cost sharing. In a recent post for the Commonwealth Fund’s To the Point blog, CHIR experts break down the recent decision and how it will impact access to care.
Stakeholder Perspectives on CMS’s 2024 Notice of Benefits and Payment Parameters: Consumer Advocates

The Biden administration is poised to finalize new rules governing the Affordable Care Act Marketplaces and insurance reforms for plan year 2024. In the second installment of our annual review of key stakeholder responses to the proposed policy changes, CHIR’s Kristen Ukeomah and Karen Davenport focus on consumer advocate comments on the proposed rule.
Happy 13th Birthday, ACA!
The State of State Protections: Maintaining Access to Services after Transitioning from Medicaid

As states resume conducting Medicaid and CHIP re-determinations of eligibility, the U.S. faces the most dramatic shift in coverage since implementation of the Affordable Care Act. As millions of people transition from Medicaid to private insurance coverage, they could experience disruptions in critical health care services. In their latest post for the Commonwealth Fund, Sabrina Corlette and Maanasa Kona review state-level continuity of care protections and actions states can take to preserve access to life-saving services for our most medically vulnerable.
Can Employer-Sponsored Insurance Be Saved? A Review of Policy Options: Limiting Provider Consolidation and Anti-Competitive Behavior

High and rising health care prices are a key driver of increased cost sharing in employer plans. A significant contributor to rising prices is the consolidation in health care provider markets. In the third post of a series on policy options to improve the affordability of employer-sponsored insurance, CHIR’s Maanasa Kona and Sabrina Corlette explore strategies to limit provider consolidation and anti-competitive behavior.
A Progress Report on Washington’s Public Option Plans

Washington State’s “public option” program is now in its third year. After initial cost and access challenges hindered the program’s reach, growing insurer participation and recent enrollment data suggest meaningful progress is being made. CHIR’s Christine Monahan and Madeline O’Brien provide an update on how Washington’s public option plans performed in the recently concluded open enrollment period, outlining key issues to watch as Washington moves forward with its first-in-the-nation program.
Secrets to a Successful Unwinding: Actions State-Based Marketplaces and Insurance Departments Can Take to Improve Coverage Transitions

States have begun conducting Medicaid redeterminations and renewals after an almost 3-year pause, a process that is being called the “Unwinding.” In their latest article for the State Health & Value Strategies program, Sabrina Corlette, Jason Levitis, and Tara Straw outline strategies state Marketplaces and insurance departments can implement to reduce coverage disruptions and ensure continuity of care.
Updates to the Navigator Resource Guide Provide Information for People Transitioning from Medicaid to Private Health Insurance

After a three-year pause on Medicaid redeterminations, states can begin the process of removing residents from their rolls beginning on April 1. Many people who are terminated from Medicaid will be eligible for free or low-cost plans through the Affordable Care Act’s Marketplaces. To help consumers and enrollment assisters during this nationwide coverage event, we’ve updated our Navigator Resource Guide with new content about transitioning between Medicaid and private health insurance.