Category: Implementing the Affordable Care Act

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

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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.

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

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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.

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

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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.

New Guidance Clarifying Preventive Services under the Affordable Care Act

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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.

The Affordable Care Act’s State Innovation Waivers: A Need for Transparency and a Role for Stakeholders

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Discussion of new “superwaiver” authority is a hot topic among many state and health policy circles. The Affordable Care Act allows states to modify key reforms beginning in 2017 through a so-called 1332 waiver application. States could also choose to coordinate this waiver with Medicaid and/or CHIP reforms through a 1115 waiver. CHIR’s Sabrina Corlette and Joan Alker of the Center for Children and Families assess the waiver process outlined to date and the need for transparency and stakeholder input on the critical policy decisions that will be required.

Activity Afoot on Essential Health Benefits

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Did you know states need to select their Essential Health Benefits (EHB) benchmark plan for 2017 in just a few weeks? If not, JoAnn Volk will tell you about the process underway and how advocates can get involved.

The opinions expressed here are solely those of the individual blog post authors and do not represent the views of Georgetown University, the Center on Health Insurance Reforms, any organization that the author is affiliated with, or the opinions of any other author who publishes on this blog.