Filed Under:Health Insurance, Individual Health

Will exchange users have to have medical homes?

(Jay Wylie, CLKER)
(Jay Wylie, CLKER)

Provider network rules, balance billing and treatment of transgender family members are some of the topics that have come up in public comments on a model contract the California health insurance exchange system is developing.

The groups submitted the comments to the board of Covered California, the entity in charge of setting up a state-based individual exchange and a state-based Small Business Health Options Program (SHOP) small-group exchange for California.

The staffers objected, for example, to Covered California's acknowledgement that insurers don't want the exchange to be a "third regulator," on top of California insurance regulators and HHS.

The National Health Law Program and Western Center "appreciate the importance of making sure that Covered California operates efficiently, and that QHPs are not over-burdened by duplicative regulatory review," the advocacy group staffers said. "That said, given Covered California’s role as an active purchaser, we urge the board to ensure that it retains a role in reviewing and evaluating QHPs’ performance in areas that are particularly important to Covered California’s mission."

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Nichole Morford

Nichole Morford
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