HIVMA Comments on Considerations for Establishment of State-based Health Insurance Exchanges
Board Chair Michael Saag, MD, filed comments on behalf of HIVMA regarding key considerations for establishment of state-based health insurance exchanges, in terms of ensuring access to quality HIV care under health insurance plans operating within the exchanges. HIVMA’s recommendations include the following:
- Having strong federal standards requiring that plans within the exchanges provide adequate access to qualified HIV medical providers;
- Advising states to educate Ryan White-funded clinics that, as “essential community providers” defined by statute, they have the option to participate in provider networks of plans offered in state health insurance exchanges
- Providing technical assistance to Ryan White clinics to develop the expertise to negotiate contracts with insurers and to bill third-party payers
- Including strong federal guidance and incentives for plans operating in the exchanges to develop reimbursement mechanisms that adequately support the medical home model of care
- Urging exchange plans to adopt of risk adjustment and other best practices developed through the Centers for Medicare and Medicaid Innovations Center;
- Providing guidance to states requiring exchange plans to employ measures developed by the National Committee for Quality Assurance, including those developed for HIV care
- Utilizing Ryan White-funded community-based programs to serve as patient navigators for people with HIV disease and potentially other low income individuals with chronic conditions
- Urging that provider directories highlight HIV providers as a distinct category in their directories, and other consumer protections to ensure that the exchanges will be consumer-friendly and accountable