Applicability of All-Payer Claims Databases for Rate Review and Other Regulatory Functions
All-payer claims databases (APCDs) collect and compile medical, pharmacy, and sometimes dental claims, eligibility, and provider files from public and private payers. APCDs are currently being used for a variety of functions, including population health analysis, comparative analysis of provider and facility quality, cost management for Medicaid and other public programs, support for provider payment reform initiatives, and consumer transparency tools.
Special Topics in Payment Reform: State Levers, Multi-Payer Approaches, and Measurement
The final webinar in a three-part series on payment reform, this presentation by Bailit Health Purchasing addresses special topics in payment reform including using state levers to implement payment reform, multi-payer strategies, and measuring delivery system performance.
Advance Premium Tax Credit Reconciliation Questions and Answers
Under the Affordable Care Act (ACA), individuals seeking health insurance coverage through a Marketplace are assessed for eligibility for an advance payment of the premium tax credit (APTC) based on projected annual income. When eligible individuals file federal income taxes at the end of the year, the Internal Revenue Service (IRS) will reconcile the premium tax credit received based on estimated annual income with what should have been received based on actual income.
Understanding the Potential Role Web Brokers Can Play in State-Based Marketplaces
he Affordable Care Act (ACA) is already greatly expanding individual health insurance coverage, particularly among lower-income uninsured individuals. However, this is neither easy nor inexpensive to sustain, and it will require ongoing, effective public-private partnerships on multiple levels. One potential partnership opportunity is with “web brokers” who sell individual health insurance online, functioning as private distribution channels in a fashion similar to the new Marketplaces and offering a choice of health plans from multiple insurers, while relying primarily on websites and call centers for customer service.
Early Impacts of the Affordable Care Act on Health Insurance Coverage in Minnesota
With full implementation of the health insurance coverage provisions of the Affordable Care Act (ACA) on January 1, 2014, there has been great interest in assessing the law’s early impact on health insurance coverage in Minnesota.
State-Based Payment Reform Models
The second webinar in a three-part series on payment reform, this presentation by Bailit Health Purchasing describes payment reform models being used by state purchasers, including how they work and their strengths and challenges.
Payment Reform 101: Why Payment Reform? What is it?
The first webinar in a three-part series on payment reform, this presentation by Bailit Health Purchasing addresses how traditional fee-for-service payment impedes state efforts to purchase value and describes the relationship between payment and delivery system reform.
Rate Development, Filing and Review – A Compilation of Guidance and Expectations for 2015 Rates Webinar
Departments of insurance and insurers are currently preparing for the next round of rate development, filing and review. Rates for 2014 were developed based on considerable speculation on the expected impact of the ACA market reforms on the number and health risk of individuals who would enroll. Early enrollment information will be available for the 2015 rate development and review process, however, robust health risk information may still be unavailable.
Department of Insurance Tools for Plan Year 2015 Form Filings and Review Webinar
With the first open enrollment period having come to an end, states are immediately gearing back up to ensure that consumers again have strong plan options available on the Marketplace for 2015. Insurers will soon be filing forms and rates with state insurance departments, and regulators will be working through those filings to certify products to be offered on the Marketplace during the next open enrollment period.
Realizing Rural Care Coordination: Considerations and Action Steps for State Policy-Makers
This issue brief draws from the experiences of six states, Alabama, Colorado, Montana, New Mexico, North Carolina, and Vermont, to identify common policy considerations and action steps for coordinating care in rural environments.