Surprise Balance Billing
States are taking the lead to address surprise balance bills – charges for unexpected, out-of-network medical care – by enacting consumer protection laws that range from strict requirements for network service disclosures to outright bans on balance billing in certain circumstances. NASHP is tracking state efforts to mitigate surprise billing and analyze the outcomes of these measures.
The National Academy for State Health Policy’s (NASHP) Hospital Cost Tool uses information from annual Medicare cost reports that are completed by hospitals and submitted to the federal government to provide health care purchasers and regulators with critical information to better understand hospital costs – versus their charges.
Rampant consolidation in nearly every state has created dominant health care systems that can use anticompetitive contracting practices to charge supracompetitive prices, especially to commercial insurance plans.
Model Act Summary: This model legislation targets health insurance contract terms that have been used by health systems to impede competition and increase prices. In particular, this model act prohibits the use of most-favored-nation clauses, anti-steering clauses, anti-tiering clauses, all-or-nothing clauses, and gag clauses in contracts between health insurers and health care providers. The prohibition […]
Family members provide significant amounts of care to relatives with complex needs, including those who are Medicaid enrollees.
A new, independent analysis of the Montana state employee health plan’s transition to reference-based pricing – which limits hospital prices to a multiple of what Medicare pays – found significant savings for the state in the two years after its implementation. Further, there is no evidence that utilization artificially increased as a result of the new payment […]
Federal efforts to increase hospital price transparency are falling short as hospitals fail to fully comply with requirements. However, states with transparency laws that give them access to comprehensive hospital financial data are using the pricing information to more fully analyze hospitals’ fiscal health and inform states’ cost containment efforts.
The National Academy for State Health Policy (NASHP) and Community Benefit Insight are hosting a TwitterChat at 3 p.m. (ET) Wednesday, April 7, 2021, as a part of National Public Health Week. It will discuss community engagement, how hospital community benefit improvement activities can address health disparities, and how this has changed as a result […]