…and make legislative recommendations. This law also required Maine’s all payer claims database to produce annual reports on facility fee charges. Based on the task force’s report, Maine lawmakers passed legislation requiring health care entities to post facility fee notices on their website and on-site. These notices must advise patients whether the entity is a hospital-based facility, and if so,…
The Affordable Care Act is a monumental act that has increased access and affordability to comprehensive health care coverage for millions of Americans. The ACA also included a number of reforms to improve health care quality. In the commercial sector, two federal programs, the Quality Improvement Strategy (QIS) program and the Quality Rating System, monitor health care quality and require…
On Tuesday, May 21st, Georgetown University’s Center on Health Insurance Reforms focused on strategies for controlling health care costs through increased market competition during the third event in its series on employer-sponsored health insurance. Event speakers included Stacy Sanders, recently appointed as the first-ever Chief Competition Officer of the U.S. Department of Health & Human Services (HHS), Professor Erin Fuse…
…AHPs functionally indistinguishable from health insurance issuers. They also argued that it would encourage unscrupulous promoters to establish AHPs, increasing the prevalence of fraudulent practices. No public comments explicitly defended the 2018 rule’s business purpose standard, although one commenter suggested revising rather than rescinding it. Geographic Commonality Standard The 2018 rule would have enabled associations to meet the commonality standard…
By Sabrina Corlette and Jason Levitis On April 2, 2024, the Centers for Medicare & Medicaid Services (CMS) released the final Notice of Benefit and Payment Parameters (NBPP) for 2025. This annual rule governs core provisions of the Affordable Care Act (ACA), including operation of the health insurance Marketplaces, standards for health plans, insurance brokers (including web-brokers), and the risk…
…and comprehensive health insurance coverage that must comply with consumer protections under the Affordable Care Act (ACA) and other federal laws. State departments of insurance are the primary agencies responsible for oversight and enforcement of the new STLDI definition and notice requirements, and existing state laws that conflict with the new federal standards are preempted. In a recent Expert Perspective…
…by a larger health system (and identify the system if applicable), if the facility charges facility fees, and direct consumers to a state agency website with more information about the circumstances in which facility fee charges are not permitted. Studying Hospital Facility Fees: Best Practices for State Policymakers Legislative requirements and study design can determine the efficacy of a facility…
…public option and capped rates, Urban Institute researchers examined the reforms’ implications for hospital finances and service populations. Researchers mirrored the methodology of Blumerberg et al (2024), then combined the HRR-level analysis with health system-level data to determine the financial characteristics of the systems most and least affected by either reform. Researchers also assessed potential access changes for the health…
…At CHIR, her research focuses on expanding access to affordable health care coverage and Medicare coverage at the state and federal levels. Before joining CHIR, Leila worked as a Healthcare Consultant at TransformCare Inc. where she conducted diagnostic evaluations and data analysis of primary care and behavioral health clinics on military bases. With this data she recommended and led implementation…
…standards to ensure access to behavioral health providers. In a recent post for the Commonwealth’s Fund To the Point blog, CHIR’s JoAnn Volk and Justin Giovannelli discuss how some states have set more stringent access standards for behavioral health providers by, for example, applying time and distance measures to a broader list of behavioral health providers. Others have incorporated mental…
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.
