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Final 2024 Payment Rule, Part 1: Insurance Market Rules And Consumer Assistance

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…Substance Use Disorder Treatment Centers, Community Mental Health Centers, Rural Health Clinics, Black Lung Clinics, Hemophilia Treatment Centers, Sexually Transmitted Disease Clinics, and Tuberculosis Clinics). The two new categories for 2024 will be: Mental Health Facilities and Substance Use Disorder (SUD) Treatment Centers, thus removing them from the “Other ECP Providers” category. This change means that issuers must attempt to…

March Research Roundup: What We’re Reading

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…Adults, The Commonwealth Fund. Researchers evaluated changes in health coverage and access for Black and Hispanic adults from 2013–2021 to assess the Affordable Care Act’s (ACA) impact on health coverage disparities across race and ethnicity. What it Finds The disparities in uninsured rates between Black, White, and Hispanic adults have significantly narrowed since the ACA took effect. Between 2013–2021: Uninsured…

Providers Challenge Payments In ‘No Surprises’ Act Dispute Resolution Process

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…A key component of the law is the federal process for determining how much a patient’s insurer or health plan will pay an out-of-network facility or provider. If the provider does not accept the payer’s initial payment, the parties must first enter into 30 days of private negotiations to try and reach an agreement on the payment amount. If negotiations…

A World Without The ACA’s Preventive Services Protections: The Impact Of The Braidwood Decision

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…access to affordable, high quality insurance coverage. One of those reforms was a requirement that employer-based health plans and health insurers cover, without cost-sharing, high-value preventive services recommended by any one of three government panels, each composed of physicians and clinical experts. Coverage for more than 100 services has been mandated so far, including cancer screenings, childhood and adult immunizations,…

Coverage of Preventive Services Without Cost Sharing in Jeopardy as Texas Court Strikes Down ACA Protection

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…invalidated much of the preventive services protection—one of the ACA’s most popular provisions. In a recent post for the Commonwealth Fund’s To the Point blog, CHIR experts break down the recent decision in Braidwood Management v. Becerra. The decision struck down, on constitutional grounds, the requirement to provide $0 coverage of a subset of preventive services recommended by an expert…

Stakeholder Perspectives on CMS’s 2024 Notice of Benefit and Payment Parameters: State Insurance Departments and Marketplaces

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…on Our Methodology This blog is intended to provide a summary of comments submitted by SBMs and state DOIs. This is not intended to be a comprehensive report of all comments on every element in the Notice of Benefit and Payment Parameters proposed rule, nor does it capture every component of the reviewed comments. For more stakeholder comments, visit https://www.regulations.gov/….

Stakeholder Perspectives on CMS’s 2024 Notice of Benefits and Payment Parameters: Consumer Advocates

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…Our Methodology This blog is intended to provide a summary of comments submitted by consumer advocacy organizations. This is not intended to be a comprehensive review of all comments on every provision in the Notice of Benefit and Payment Parameters proposed rule, nor does it capture every component of the reviewed comments. To view more stakeholder comments, please visit https://www.regulations.gov/….

Biden’s Budget Sets Up a Spending Showdown, With ACA Subsidies in the Crosshairs

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…counterproposals on health care spending have not been released, key congressional stakeholders, including the House Ways and Means Committee and House Budget Committee, have already pushed back on many of President Biden’s proposals. Additionally, budget analysis suggests that Medicaid, the Children’s Health Insurance Program (CHIP), and Marketplace funding would have to be cut by 70 percent in order to achieve…

Stakeholder Perspectives on CMS’s 2024 Notice of Benefit and Payment Parameters: Health Insurers

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…This blog is intended to provide a summary of comments submitted by insurance companies and representative associations. This is not intended to be a comprehensive review of all comments on every provision in the Notice of Benefit and Payment Parameters proposed rule, nor does it capture every component of the reviewed comments. To view more stakeholder comments, please visit https://www.regulations.gov/….

Questionable Conduct: Allegations Against Insurers Acting as Third-Party Administrators

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…available hospital pricing data—the source plaintiffs relied on to calculate the alleged overpayments because they couldn’t access their own claims data. Elevance argues, for instance, that the hospital-released data may reflect out-of-date negotiated rates or base rates that may go up or down depending on the procedure’s complexity. Other plans have also accused insurer-TPAs of overpaying claims. A union health…

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.