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Templates & Toolkits

The State Network team at the Georgetown University Health Policy Institute previously developed a toolkit to assist insurance regulators in assuring that Department of Insurance consumer service representatives (CSRs) are well versed in all aspects of insurance basics (for new staff), as well as the changes brought about by the ACA and other recent reforms. The information in this document has recently been added to the consumer services toolkit, and includes updated information on marketplace financial assistance and related tax filing issues, including Form 1095-A.

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Date Created: Jan 27, 2015


Issue Brief , Regulatory Analysis

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…

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Date Created: Jan 23, 2015


Issue Brief

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…

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Date Created: Jan 23, 2015


Webinar

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.

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Date Created: Dec 15, 2014


Templates & Toolkits

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.

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Date Created: Oct 27, 2014


State Materials , Templates & Toolkits

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.

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Date Created: Oct 17, 2014


Issue Brief , Regulatory Analysis

As health care costs rise, one of the chief determinants of the rate of increase has been the cost of prescription drugs. Over time, additional tiers have been included in pharmacy benefit designs and, as they were added, cost sharing in the new, higher tiers has increased.

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Date Created: Aug 15, 2014


Meetings & Presentations , State Materials , Webinar

As the 2015 open enrollment period approaches, one of the most significant challenges faced by marketplaces stems from the complicated nature of premium subsidy calculations, which may lead to potentially large swings in consumers’ after-subsidy premiums and could have tax liability implications.

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Date Created: Aug 12, 2014


Issue Brief , Regulatory Analysis

As the 2015 open enrollment period approaches, one of the most significant challenges faced by marketplaces stems from the complicated nature of premium subsidy calculations, which may lead to potentially large swings in consumers’ after-subsidy premiums and tax liability implications.

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Date Created: Aug 7, 2014


Meetings & Presentations , Regulatory Analysis , Work Plans & Timelines

The State Network hosted a Small Group Convening in Boston, MA on July 10-11, 2014, bringing together state officials and technical experts to discuss QHP and IAP renewals in advance of the upcoming open enrollment period. The meeting provided officials from several states within and outside of State Network an opportunity to discuss strategies for confronting potential issues related to the renewals process.

Date Created: Jul 18, 2014