On November 15, 2023, the Centers for Medicare & Medicaid Services released its proposed 2025 Notice of Benefit and Payment Parameters, the annual regulation which governs core provisions of the Affordable Care Act. This expert perspective focuses on aspects of the proposed rule likely to be of interest to state officials, including requirements for State-Based Marketplaces to align with the standards of the Federally Facilitated Marketplace, proposals for states to update essential health benefits, and initiatives to ease the eligibility and enrollment process for consumers.
Safeguarding Financial Stability of Provider Risk-Bearing Organizations
On October 23, State Health and Value Strategies hosted a webinar that explored state options for regulating provider risk-bearing organizations. The push to better manage costs and improve quality is resulting in payment models that transfer financial risk and accountability from payers to providers. An increasing number of provider organizations are entering into risk-based contracts with payers where they are accepting the financial risk of care. This financial liability is often shared with payers, and maximum risk exposure is typically capped. During the webinar, technical experts from Bailit Health reviewed approaches states could take to overseeing their risk-bearing organizations and highlighted examples from states that have elected to regulate to protect against provider insolvency.
For more information and details on state approaches, see the companion issue brief: Safeguarding Financial Stability of Provider Risk-Bearing Organizations