Issue Briefs | Jan 23, 2015

Reference Pricing: An Overview and Suggested Policy Considerations

Kayla Connor and David Cusano, Georgetown Health Policy Institute, Center on Health Insurance Reforms

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 motivating 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.  There are a number of factors that state and federal regulators should consider when reviewing plans that apply the pricing method, which are summarized in the issue brief, along with other policy considerations.


Expert Perspectives

November 22, 2024

Information Sharing Considerations for Implementing the Consolidated Appropriations Act’s Requirements for Justice-Involved Children and Youth

This expert perspective reviews the information sharing considerations for states in implementing the Consolidated Appropriations Act’s (CAA) requirements to provide targeted case management and screening and diagnostic services for children and youth who are incarcerated and enrolled in Medicaid or CHIP. The expert perspective highlights key areas of CAA implementation that require information sharing, which states will need to consider as they work towards coming into full compliance.

November 15, 2024

CMS Releases Guidance on Optional Long-Term Use of Unwinding-Related Section 1902(e)(14) Waivers

On November 14, 2024, CMS released its second installment in its series of Medicaid and CHIP guidance intended to support state efforts to verify eligibility and conduct renewals in compliance with federal Medicaid and CHIP requirements. A new expert perspective summarizes the latest CMCS Informational Bulletin and accompanying slide deck which address the continued use of unwinding-related section 1902(e)(14) waivers beyond the previously established expiration date of June 30, 2025.