Policy Synopses at the Federal and State Level

Stacey Kram, Salisbury University

Federally Facilitated Changes• Created by the Robert Wood

Johnson Foundation

• Discusses the implications of state versus federally run insurance exchanges

What is an Exchange?

• One stop shopping

• State-run

• Regionally –run

• Federally facilitated

The Core Functions of an Exchange

• Setting eligibility requirements

• Enrollment assistance

• Plan management specifications

• Consumer assistance

• Financial management

Foreseen Complications with Federally Facilitated Exchanges

• States will have locally and federally regulated plans simultaneously

• Meeting local regulations of various states

• “Churning”

More Complications…

• “Adverse selection threats”

• Limits on Medicaid expansion

• Customer service

A More Practical Approach?

• Creation of state-based exchanges

• Expansion of Medicaid

• Extending deadlines to states

• Offering establishment grants

Telehealth Provider Credentialing

• MD House Bill 1042, introduced February 8, 2013

• Discusses overcoming barriers to telehealth delivery

Current Complications

• CMS requirements for reimbursement

• Legislation slow to change at state level

• Excessive cost and burden to rural organizations and telemedicine providers

More Complications…

• Limited access to specialty care

• Single-site provider is cost-prohibitive

• Current estimate of $4.8 million annually for one provider

A More Practical Approach?

• Credentialing by Proxy

• Federal Credentialing Program for Health Care Providers– VetPro

References

• Health Affairs. (2013, January). Federally facilitated exchanges. Retrieved from: http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_84.pdf

• Hospitals-Credentialing and Privileging Process-Telemedicine, MD- H.B. 1042, 2013 Regular Season. (2013).

 • National Rural Health Association. (2010).

Telehealth provider credentialing. Retrieved from: http://www.nrharural.org