Tag Archives: State government

Section 1115 waivers provide emergency support options

The coronavirus has forced states to build emergency action plans for their Medicaid programs at lightning speed. Nearly all have begun with the Section 1135 “blanket waivers” issued by the Centers for Medicare and Medicaid Services (CMS), but as the pandemic continues, many are seeking additional options.

A variety of broader policy and expenditure options are available under emergency 1115 waivers and other federal authorities to support states with accelerated access to emergency assistance for Medicaid recipients and healthcare providers. In this paper, Milliman consultants discuss options for states to consider as they build their emergency response.

Supplemental health benefits considerations for small insurers

Supplemental health products have experienced consistent market growth over the years, most noticeably since the implementation of the Patient Protection and Affordable Care Act (ACA). This growth has been especially strong for hospital indemnity, critical illness, and accident products. There has been a significant increase in the number of insurance companies selling these products. Small companies in this market need to understand the unique challenges these products present in order to compete effectively.

Understanding the market landscape and the assumptions that are required in order to develop premium rates for supplemental health products is important. Three areas that create rate challenges for insurers in supplemental health markets are (1) states with high minimum loss ratio requirements, (2) ongoing monitoring requirements, and (3) the need for rate flexibility. Insurers also need to be aware of the volatile regulatory environment and need to consider issues regarding product flexibility and distribution.

This article by Milliman’s Jennifer Howard and Stacy Koron goes into more detail on the challenges that supplemental products can present.

How can state government encourage care providers to implement EHR?

Ed Boyle submitted a question via Facebook:

“With so much focus being placed on hospitals and clinics implementing electronic patient information systems, what – if anything – can state and/or federal government do to help support/alleviate the sometimes significant amount of time it takes physicians and clinicians to learn and become proficient at using a clinical information system – thus amounting to less time for patient care during that learning-curve period?”

For submitting this question, Ed Boyle is a finalist in our question contest. Congratulations, Ed.

Transcript

Q: What can the state and/or federal government do to help physicians learn the clinical information systems without detracting from patient care?

Mike Kreidler: The answer is “yes, there is.” We’re working on administrative simplification so that physicians and payers can process claims in a timely fashion in  a common format. The current system is antiquated. Even the rules that have been put forth for the various coding (by federal definition) have significant variations. There are format interpretation differences between one carrier or another. You’ve got to standardize that. Continue reading