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Adoption of Value-Based, Alternative Payment Models: Where Are We Today and Where Do We Go from Here?

Posted January 31, 2022 by Maanasa Kona

…such as capitation, ACOs, and bundled payments. While three of these states reported cost savings from these efforts, many states found that providers were resistant to risk-sharing agreements, particularly those that resulted in the providers losing money if costs exceed certain benchmarks (also known as “downside risk”). Adoption of APMs in the Commercial Sector Adoption of APMs in the commercial…

CHIR Welcomes New Faculty & Staff, Jalisa Clark & Emma Walsh-Alker

Posted January 28, 2022 by CHIR Faculty

…health insurance. She also provides administrative support and helps manage communications and social media for CHIR. Prior to her position at CHIR, Emma served as an Administrator for the Biden Health Policy Committee, helping to facilitate development of equitable public health policy for the campaign. She has previously worked on education and labor issues at Georgetown’s Center on Education and…

Fixing the Family Glitch and Other Priorities: The Next Wave of Federal Administrative Action to Enhance the Affordable Care Act

Posted January 20, 2022 by Katie Keith

Last year was a busy time for health policy. After a change in administration in the midst of the ongoing COVID-19 pandemic, we saw numerous federal policy changes to strengthen the Affordable Care Act (ACA) and Medicaid program. Policymakers weren’t going it alone; stakeholders weighed in on health policy priorities, outlining administrative actions to increase access to affordable, comprehensive health…

December Research Roundup: What We’re Reading

Posted January 18, 2022 by Emma Walsh-Alker

…Association of Medicaid vs Marketplace Eligibility on Maternal Coverage and Access With Prenatal and Postpartum Care, JAMA Network Open, December 6, 2021. Researchers used data from the Pregnancy Risk Assessment Monitoring System to evaluate access to maternal health care for women with incomes between 100 and 138 percent of the federal poverty level (FPL). The authors compared differences in pregnancy-related…

Navigator Guide FAQs of the Week: Answers to Post-Enrollment Questions

Posted January 18, 2022 by Emma Walsh-Alker

…here. What is a balance bill and how can I avoid it? “Balance bills,” often referred to as surprise medical bills, can occur in two circumstances that can come as a surprise to patients: 1) When you receive emergency care either at an out-of-network facility or from an out-of-network provider, including air ambulances; or 2) When you receive elective nonemergency…

Changes to Wellness Programs Suggest Employers are Rethinking Health Promotion

Posted January 12, 2022 by CHIR Faculty

…dynamics, KFF’s 2021 survey specifically probed employers’ use of biometric screenings and health promotion activities. On biometric screenings, they found that 38 percent of large firms (more than 200 workers) offered employees the opportunity to complete a screening in 2021, compared to 50 percent of large firms offering this service in 2020, while small and large firms reduced or eliminated…

The New Year Brings New Protection Against Surprise Medical Bills: What Consumers Need to Know

Posted January 7, 2022 by JoAnn Volk

…is scheduled to occur in less than 72 hours). Consumers who feel coerced into signing away their rights can file a complaint with the federal NSA Help Desk by calling 1-800-985-3059 or visiting https://www.cms.gov/nosurprises. What should a consumer do if they believe they were balance billed without their consent? Consumers can contact their health plan or insurer for an explanation…

The Proposed 2023 Notice of Benefit & Payment Parameters: Implications for States

Posted January 7, 2022 by

On December 28, 2021, the Centers for Medicare & Medicaid Services (CMS) released its proposed Notice of Benefit & Payment Parameters for plan year 2023. This annual regulation governs core provisions of the Affordable Care Act (ACA), including operation of the health insurance marketplaces, standards for insurers, and the risk adjustment program. In her latest Expert Perspective for the State…

Navigator Guide FAQs of the Week: Understanding Common Consumer Notices When Applying for Marketplace Coverage

Posted January 7, 2022 by Emma Walsh-Alker

…matching issue on my application and the marketplace needs to verify my income. How should I verify my income? A data matching issue means the marketplace is not able to verify the information on your application based on the data the marketplace already has for you. To resolve the data matching issue with your application, the marketplace is likely to…

ACA Section 1557 as a Tool for Anti-racist Health Care

Posted December 17, 2021 by Katie Keith

…racial justice. Examples include: Identifying benefit and network designs that discriminate based on race; Imposing affirmative obligations on covered entities (such as ensuring that algorithms are not biased or discriminatory); Requiring the collection and reporting of demographic data; Taking targeted enforcement action; and Conducting a compliance review initiative focused on maternal health disparities. You can read the full piece here….