Excepted benefits and short-term, limited-duration insurance are insurance products that are exempted from the Affordable Care Act’s (ACA) consumer protections. Recent questions from several states have indicated that some confusion exists about which insurance products qualify as “excepted benefits” and are therefore exempt from several requirements of the ACA, such as coverage for preventive health services, a prohibition on lifetime limits, and minimum value requirements…
Reference pricing is intended to reduce medical costs both for insurers and for purchasers of health care services, encouraging enrollees to obtain services from lower-cost providers and motivates higher cost providers to lower their reimbursement rates for those same services. This issue brief, prepared by the Georgetown Health Policy Institute’s Center of Health Insurance Reforms, provides an overview of this pricing method and federal guidance that has been issued to date…
This suite of issue briefs is geared toward states interesting in value-based purchasing for health care. Part 1 deals with strategic considerations, Part 2 offers an implementation guide, while Part 3 includes a planning template for state purchasers.
Individual and Family Engagement in the Medicaid Population: Emerging Best Practices and Recommendations
In this issue brief, The Institute for Patient- and Family-Centered Care (IPFCC) outlines action-oriented recommendations and strategies to support enhanced individual and family engagement efforts in Medicaid. Research shows that engaged individuals and families actively working with their health care teams have better outcomes, often choose less expensive options when participating in shared decision-making, and express greater satisfaction with their health care experiences.
Approaches to the Integration of Services for Individuals with Intellectual and Other Developmental Disabilities
Based on interviews conducted with I/DD staff in six states, this paper highlights approaches to integrating services within the Medicaid program for individuals with I/DD, and lessons learned from states with integration activities underway.
This webinar addressed which ACA provisions are waivable, including the individual mandate, the employer mandate, essential health benefits, and exchange standards; how the coverage and fiscal guardrails might be applied by HHS and Treasury, which have yet to provide much guidance beyond a regulation that defines the waiver application process; and how 1332 waivers might be combined with Medicaid 1115 waivers to better achieve state goals across programs.
This network adequacy planning tool for states provides an overview of the U.S. Department of Health and Human Services (HHS) regulation on minimum network adequacy standards. The tool is in Word format, and is designed to be used as a template to assist states in developing analysis plans that will inform discussions around updating network adequacy standards.
During the initial open enrollment period under the Affordable Care Act, the federal government and states operating state-based exchanges conducted various types of reporting on key indicators of interest to policymakers and the public.
As those interested in conducting surveys to measure the public’s participation and experience in health insurance marketplaces under the Affordable Care Act (ACA) continue to investigate the most effective ways of doing so, access to questions utilized in previously conducted surveys will be very useful.
Tailored to the needs of state officials and other stakeholders involved in measure set creation, this webinar addresses strategies for developing and maintaining aligned quality measure sets.