The Peach Pulse: February 2016

Getting What You Pay For

groupGHF and Georgia Watch host policy forum on network adequacy, surprise out-of-network billing, and provider directory accuracy.

Early in February, GHF and Georgia Watch partnered to host policymakers, stakeholders, and advocates at a policy panel on important health insurance consumer protections. The event opened with remarks from Senator Dean Burke and included presentations from Consumers Union’s Julie Silas, Georgia Watch’s Beth Stephens, and GHF’s Meredith Gonsahn. If you missed the event, you can find presentations and materials below!

Julie Silas’s presentation: Finding Policy Solutions for Provider Directories and Surprise Medical Bills

Meredith Gonsahn’s presentation: Improving Network Adequacy and Provider Directory Standards in Georgia

Video interviews with Julie Silas on network adequacy and provider directories

Who was there? Check out the photo album.

New Policy Briefs

network-adequacy-briefEnsuring Access to Care: Setting and Enforcing Network Adequacy Standards 

When consumers enroll in a health insurance plan, they gain access to a network of medical providers. This network must be adequate to ensure that consumers enrolled in the plan have reasonable access to all covered benefits. The goals of this policy brief are to:

-explain the importance of network adequacy for access to care

-outline current network adequacy standards in Georgia

-summarize recent policy activity around network adequacy

-set forth consumer-oriented principles for network adequacy standards in Georgia

-provide policy recommendations to achieve network adequacy in Georgia.

Download the brief.

provider-directory-briefEnsuring Access to Care: Improving Provider Directory Accuracy and Usability

Provider directories are the primary tool available to consumers to determine whether the plan they are selecting has a narrow or broad network and to identify which providers are in their plan. As such,these directories should be accurate, up-to-date, and should truly function as a tool. The Georgia Legislature has taken the first steps to addressing these issues through SB 302, the Provider Directory Improvement Act. The bill passed unanimously in the Senate and is now in the House Insurance Committee for consideration.The goals of this policy brief are to:

-explain the role provider directories play as a tool for consumer decision-making

-describe current provider directory provision in Georgia

-describe common problems with provider directories

-outline recent policy activity around provider directories

-highlight other state examples of provider directory improvments

Download the brief.

Legislative Updates

Mental.Health.Day_Jan.2016_edittedGHF and partners take to the Gold Dome! 

Whitney and Laura have been spending extra time at the Capitol lately with our coalition partners. Many organizations host lobby days during the legislative session when grassroots advocates can come to the Capitol to make legislators aware of issues that they care about and advocate for relevant legislation. Our partner organizations have invited GHF to attend many lobby days to talk to their attendees about closing Georgia’s coverage gap and other items on our policy agenda. Whitney and Laura have also provided coverage gap lapel stickers so this issue is visible to all people in the Capitol, especially legislators. Thank you to all our partners for sharing your lobby days with us and helping to foster new coverage gap advocates!

Consumer Health Care at the Capitol
Throughout the session we’ve been sending weekly legislative updates about the issues we’re following at the Capitol, such as the Provider Directory Improvement Act, proposals to close the coverage gap, and other bills that could impact your health care. If you missed an email, you can find all updates here. You can also see all the bills we’re tracking here.

GEAR Update: Special Enrollment Period Changes 

We want to hear from you – new SEP rules! 
At the beginning of last year’s open enrollment period, GHF created GEAR, the Georgia Enrollment Assister Resource Network (GEAR). GEAR is a coalition of enrollment assisters and those closely involved in the enrollment process. Now the open enrollment is passed, GEAR is turning to tax time and special enrollment periods (SEPs). Last month, CMS announced the new special enrollment confirmation process. Georgians will now be required to provide sufficient proof to the marketplace to determine their SEP eligibility. Failure to provide supporting documents may lead to the denial of coverage. At GHF we advocate for policies that make enrollment in health insurance more inclusive and  fight policies that put up unnecessary barriers. We want to hear from you about this! If you’re an enrollment assister and are experiencing trouble enrolling consumers during a special enrollment period, let us know! If you’d like to join the GEAR network, you can do that here.

GHF Welcomes New Board Members

Haque-aliyyaAliyya Haque
Aliyya Haque is an associate in Alston & Bird’s Products Liability group. She represents industry in scientifically-complex matters, typically involving toxic tort, product liability, ad consumer fraud allegations. Aliyya specializes in working with experts to communicate the client’s scientific case to a non-technical audience. Representative industries include telecommunications, food and beverage, chemicals and minerals, automotive and home construction products. Aliyya received her J.D. from Emory University School of Law. Prior to attending law school, she obtained a M.P.H in health systems management from Tulane University and a B.A. in human biology and a minor in art history from Stanford University.

Caley_headshot_2014-300x300-1Sylvia Caley

Sylvia returns to the GHF’s board of directors. She is an associate clinical professor at Georgia State University and is director of the Health Law Partnership (HeLP), a medical-legal community collaboration among Children’s Healthcare of Atlanta, the Atlanta Legal Aid Society and the College of Law at Georgia State. Caley has extensive experience in health care, health law and policy, and poverty law, and her work-related interests have centered on the intersection of health and poverty. She is a member of the Grady Health System Ethics Committee and the Children’s Healthcare of Atlanta Bioethics and public Affairs Committee. Caley teaches courses on health policy and legislation and clinical skills. She also lectures extensively on legal issues affecting child health and well-being


GHF in the News

Closer Look – WABE
59:18: Cindy Zeldin, executive directory og GHF, expamines current state legislation related to healthcare and health policy.

A small, surprising step toward a big change in health coverage? – Georgia Health News
“The bill may not get very far this year, with time running out in the General Assembly session and without the fiscal impact yet studied. But a Senate health committee broke new ground by holding a legislative hearing on a proposal, SB 368, that would create a Medicaid expansion alternative in Georgia…”

ACA enrollment tops 587,000 in Ga., but insurers nervous over sign up rules – Georgia Health News
“More than 580,000 Georgians signed up for coverage in the insurance exchange during the third open enrollment for the Affordable Care Act…”

Bipartisan Cooperation on Health Care in Georgia, But Not Medicaid Expansion – Atlanta Progressive News
“Medicaid expansion may be dead for the year, but there appears to be bipartisan cooperation on other health policy issues..”