Insurance

The Regulation of the Individual Health Insurance Market. Factors Utilized in Rating Practices in the Absence of State Regulation

Medical underwriting (examining health status) is the process that insurers use to evaluate an application for insurance.

The Regulation of the Individual Health Insurance Market. Rating Practices

With some variation, there are two distinct approaches to rating methods, or the process by which insurers calculate policy premiums, allowed by states.

The Regulation of the Individual Health Insurance Market. Access

States have sought to improve access to insurance policies through several regulatory approaches.

The Regulation of the Individual Health Insurance Market. Major Regulations

Every state has adopted certain basic standards for health insurance that apply to all types of health insurance products. These standards protect consumers by requiring insurers to be financially solvent and capable of paying claims, pay claims promptly, and adhere to certain market conduct requirements. Regulation begins with the licensing o

The Regulation of the Individual Health Insurance Market. Background

The business of insurance, including health insurance, has traditionally been regulated at the state level. States license entities that offer health insurance coverage and have established laws that control their structure, finances, and obligations to the people that they insure. However, a number of federal laws also have an impact on priva

State Nursing Home Quality Improvement Programs: Site Visit and Synthesis Report. Aspects of Texas's Quality Improvement Programs Noted to be Less Successful

During our visit we heard several concerns from provider representatives, particularly regarding the Quality Monitor Program. Many of these less positive comments appear to have been influenced by differences of opinion regarding the type of technical assistance that DHS should be giving providers under the new program. Some had expected that the

State Nursing Home Quality Improvement Programs: Site Visit and Synthesis Report. Texas Department on Aging/ Ombudsman Restraint Reduction Initiative

In addition to the programs described above, the Ombudsman and his staff, who have a presence in facilities, are conducting training on resident centered care. Restraints were chosen as a focus because they are a long-standing issue with consumer advocates, restraint use is notably high in Texas and currently a major DHS concern, and the Departme

Trends in Premiums in the Small Group and Individual Insurance Markets, 2008-2011

20121119 PremTrendsRptFnl.pdf
PDF

State Nursing Home Quality Improvement Programs: Site Visit and Synthesis Report. Aspects of Iowa's Quality Improvement Programs Noted to be Less Successful

Although there was agreement that nursing facilities appreciated recognition for good performance, there was concern expressed by the Ombudsman that these awards gave consumers a false sense of security. In their experience, they noted that consumers seeing a Best Practice icon on the website or a Deficiency Free Certificate assumed that the facil

State Nursing Home Quality Improvement Programs: Site Visit and Synthesis Report. Summary and Conclusions

Since 1999, Florida has established and implemented a number of quality improvement programs including a technical assistance program, public reporting measures, recognition programs, training/education efforts, risk management requirements and mandated increases in minimum direct care staffing. All of these measures stem from legislative mandates

State Nursing Home Quality Improvement Programs: Site Visit and Synthesis Report. Impact of Florida's Quality Improvement Programs on Quality of Life/Quality of Care

No formal evaluation of Florida's quality improvement programs has been performed to date. AHCA staff reported that they are interested in evaluating the success of the programs, particularly the TA component. However, because the programs have been operating only a short time, it is not yet possible to evaluate their impact. Because many of the p

State Nursing Home Quality Improvement Programs: Site Visit and Synthesis Report. Aspects of Florida's Quality Improvement Programs Noted to be Less Successful

Although some discussion participants praised the Quality Monitoring program, consumer advocates voiced some concerns, primarily because of the changes that were made to the original role and responsibilities as laid out in HB 1971 in 1999. The program as initially enacted was seen as separate from the survey agency and allowed the monitors to foc

State Nursing Home Quality Improvement Programs: Site Visit and Synthesis Report. Aspects of Florida's Quality Improvement Programs Noted to Work Well

Some provider representatives asserted that the Quality Monitors, Gold Seal and Risk Management are programs that have impacted the quality of care in their facilities. Although opinion on the value of the Quality Monitor program was mixed, some provider representatives expressed that they found the visits to be very helpful, describing them as pr

State Nursing Home Quality Improvement Programs: Site Visit and Synthesis Report. Overall Intent/Vision for Florida's Quality Improvement Programs

The vision of Florida's quality improvement programs, as expressed upon the passage of SB 1202, was to bring about an improvement in quality of care through a combination of risk management and internal quality assurance along with increased oversight and guidance to facilities.

State Nursing Home Quality Improvement Programs: Site Visit and Synthesis Report. Impetus for Florida's Quality Improvement Programs

Florida's quality improvement programs are the result of legislation passed in 1999, 2000 and 2001. Prior to the passage of the legislation, respondents explained that the atmosphere in the state was unsettled with a number of issues facing nursing home providers, regulators and consumers. There was increasing concern with the quality of care in n

Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. Appendix M. Glossary

Accountable Care Organization (ACO)

Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. Home Health Care Processes

EMHC staff described the clinical workflow processes for care and how information is used and exchanged. Table J-6 describes the process, information collected and/or exchanged and observations by staff. TABLE J-6. Home Health Care Workflow Processes

Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. Data Sent to HealthInfoNet by Eastern Maine HomeCare

HIN has a Home Care and Hospice Data View, which presents summary of care document information sent by the EMHC EHR. The summary of care document includes medication and laboratory data from the home care POC. There are two other HHAs and two SNFs participating on HIN. They have access to HIN data and send ADT alerts and diagnoses for the proble

Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. Overview of HealthInfoNet Providers and Health Information Exchanged

All 38 of Maine's acute care hospitals are under contract to connect to the HIE. HIN has 34 of the 38 hospitals connected, 376 ambulatory provider sites including primary and specialty care practices, FQHCs, mental health agencies, home health and two long-term care providers. Throughout 2013, HIN will work to establish connections with the four r

Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. Eastern Maine HomeCare

EMHC is an affiliate and the home care and hospice division of EMHS. In 2012, the EMHC covered nearly 1.37 million miles to make 68,323 home care, hospice, and telehealth visits to 3,300 patients. 4 Lisa Harvey-McPherson, RN, MBA, MPPM is the President and CEO of EMHC and Vice President of Continuum of Care for EMHS. During interviews, EMHS CE

Content by Keyword: Insurance