Federal regulations state that in order to be certified as a Qualified Health Plan in a Federally-facilitated marketplace, plans must be considered “meaningfully different” from all other plans in their subgroup. This document, prepared by the Georgetown Health Policy Institute’s Center on Health Insurance Reforms, is intended to help insurance regulators to understand meaningful difference standards and the ways in which they are applied by CMS.
Stemming from training at insurance departments in various State Network states, Georgetown University Health Policy Institute (Georgetown) has released updated form review checklists. These resources are designed to help insurance regulators effectively implement Affordable Care Act (ACA) provisions, regulations, and other guidance by ensuring that insurance forms submitted by carriers meet all the ACA requirements.
This webinar explored considerations for 2016 rate development, filing and review based on a compilation of CMS regulations and guidance as well as insights from Wakely Consulting Group Actuaries.
Department of Insurance Consumer Services ACA Toolkit – Marketplace Financial Assistance and Tax Filing Issues, including Form 1095-A
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.
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 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 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.