…parameters of air ambulance coverage under the Medicaid program. Solicit competitive bids from air ambulance providers to serve as the sole provider within a prescribed geographic area within the state. Create a centralized call center that would direct all calls for air ambulance services to the approved providers. Make regular flat payments to these providers (instead of reimbursing on a…
…U.S. Department of Homeland Security’s “Public Charge” rule, which broadens the types of public benefits that would count against an immigrant’s application for admission to the U.S. or permanent residency. While marketplace premium tax credits are not on the list of “public benefits” in the rule, assisters working with immigrant communities need to be aware of potential risks associated with…
…and cover far fewer benefits than an ACA-compliant plan, often leaving enrollees with substantial medical bills if they need care. Short-term plans also pose risks to the ACA-compliant individual market by siphoning away healthy people who can pass a health status screening. While the new federal standards promote short-term plans as a long-term coverage option, states can act to protect…
…Affairs; July 1, 2019. Researchers at Harvard University analyzed national survey data from the American Community Survey to find how the ACA has impacted different populations of workers. What It Finds Beginning in 2014, uninsurance rates dropped across all occupation groups. Workers in traditionally “blue-collar” industries (the service industry, farming, construction, and transportation) had the largest coverage gains after ACA…
…plans and many other non-ACA-compliant products do not meet this requirement. To ensure compliance, the rule compels employees to sign an attestation indicating that they have met this requirement. Employers who rely on this attestation will largely be held harmless if it is later found to be incorrect. Unfortunately, evidence suggests that consumers may not always know what they’re buying….
…regulators have few options to protect their markets. It’s unclear whether many employers will see the new option as a credible alternative to traditional group health coverage. Yet in an economic downturn, fixed-dollar accounts could become attractive to employers looking to keep labor costs predictable. In a new post for the Commonwealth Fund’s To the Point, we look at the…
…non-grandfathered individual and small group plans must cover, a standard that protects access to comprehensive, affordable insurance and prevents insurers from “cherry picking” healthy enrollees through benefit design. With the federal court case looming, state policymakers and advocates are looking for ways to preserve access to coverage in the absence of the ACA’s protections. One option is to codify the…
By: Jack Hoadley, Kevin Lucia, and Maanasa Kona This year has seen increased reporting on the issue of balance billing and a flurry of state-level action to solve it. Balance billing occurs when patients who are covered by insurance seek medically necessary care from out-of-network providers either due to an emergency or because an in-network facility used the services of…
…their control, they receive services from an out-of-network provider. But stakeholders remain at odds on how best to protect consumers. During the committee debate, Sen. Bill Cassidy (R-LA), the sponsor of a competing bipartisan bill, suggested that S. 1895’s approach to resolving out-of-network payment disputes “is entirely for the insurance companies” and called for an approach more favored by provider…
By Rachel Schwab and JoAnn Volk Last week, Pennsylvania Governor Tom Wolf signed legislation to establish a state-based health insurance marketplace. Under the Affordable Care Act (ACA), states are required to establish marketplaces to facilitate the sale of comprehensive health plans, either as a state-based marketplace or as a part of the federally facilitated marketplace. While the law anticipated that…
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