Payment Reform

As Congress and the Trump Administration propose strategies to address surprise balance billing – charges for unexpected, out-of-network medical care – states have significant experience in implementing surprise billing laws that can inform the discussion. Importantly, state authority cannot protect individuals covered by self-insured plans, which are pre-empted by Employee Retirement Income Security Act (ERISA,) […]

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  • State Health Policy Blog

    Maryland Passes Nation’s First Prescription Drug Affordability Board Legislation

    On April 8, 2019, the Maryland General Assembly passed legislation that which would create the first state Prescription Drug Affordability Board (PDAB) to address the costs of certain high-priced drugs in Maryland. Gov. Larry Hogan has until May 31, 2019, to sign or veto the bill. If he signs the bill or does nothing, the […]

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  • Publications

    State Initiatives Using Purchasing Power to Achieve Drug Cost Containment

    This report focuses on several state purchasing strategies designed to achieve concessions in negotiations with drug manufacturers and in other parts of the prescription drug supply chain. The highlighted strategies include intrastate actions, which combine state agencies’ purchases of drugs to improve their negotiating clout, and interstate activities, such as multi-state organizations that unite to […]

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    April 15, 2019 | Filed under: Featured-Rx, Front Page-Rx, Medicaid, Payment Reform, Publications

  • Publications

    Cross-Agency Strategies to Curb Health Care Costs: Leveraging State Purchasing Power

    Rising health care costs are an intractable problem in the United States, but states, faced with balanced budget requirements and growing voter concern, aren’t waiting for a federal solution. This report explores state initiatives to curb health care costs by:  Leveraging Medicare’s well-established reimbursement rates as reference prices for state employee plans to address rising […]

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  • State Health Policy Blog

    State and Federal Resources to Address Surprise Medical Balance Billing

    Surprise medical balance bills – charges for unexpected, out-of-network medical care – affect thousands of consumers each year. These bills can leave consumers stuck with hundreds, if not thousands, of dollars in unexpected medical expenses. States are taking the lead in cracking down on surprise balance bills, passing consumer protection laws that range from strict […]

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    April 8, 2019 | Filed under: Front Page, Payment Reform, State Health Policy Blog

  • States Lead on Surprise Medical Billing Protections, Congress Poised to Follow

    Information below references federal bills developed prior to January 2019. For an updated version of this chart, click here.

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    April 8, 2019 | Filed under: Charts, Payment Reform

  • State Health Policy Blog

    Colorado Develops New Payment Method for Physician-Administered Drugs – with the Potential to Save Millions

    The National Academy for State Health Policy (NASHP) provided a grant to the Colorado Department of Health Care Policy and Financing to develop a new payment methodology for physician-administered drugs (PADs). PADs are drugs delivered by intravenous infusion or injection in clinical settings. The category includes costly drugs, such as chemotherapy and other specialty medications. […]

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  • State Health Policy Blog

    Highlights of States’ ‘Surprise’ Medical Balance Billing Laws

    Surprise balance bills occur when patients receive unanticipated charges for health care services because they were unaware that care was delivered by an out-of-network provider or facility. In some cases, surprise balance bills can amount to hundreds if not thousands of dollars in medical expenses. A growing number of states have passed or are proposing […]

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  • Comparison of Bills Creating State Prescription Drug Affordability Review Boards

    A growing number of states are considering legislation to create prescription drug affordability review boards during the 2019 session. These boards would enable states to set “allowable rates” for certain high-cost drugs identified by the board, similar to the approach states use to regulate utilities or insurance premiums. NASHP released drug affordability review board model […]

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  • State Health Policy Blog

    Hospital Price Transparency: The Next Frontier

    The Centers for Medicare & Medicaid Services (CMS) took an important first step toward increasing the  transparency of hospital finances when it required hospitals to post their charge information, effective January 2019. But, these charges are not prices paid — they are typically the starting point against which commercial payers negotiate discounts. States with all-payer […]

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