Milestone: Establish policies that allow individuals to maintain continuity of care and providers when their insurance coverage changes
Maintaining continuity of care and providers is associated with enhanced coordination and decreased fragmentation. Changes in insurance coverage, however, can disrupt continuity. State policies can help minimize these disruptions.
*Full name: Establish policies that allow individuals to maintain continuity of care and providers when their insurance coverage changes among plans in the exchange, or between the Exchange, Medicaid, or CHIP.
*Relevance to the ACA:
Several ACA provisions can support state efforts to promote continuity of providers and care (especially for essential benefits) when individuals transition across payers. These provisions define essential benefits and require transparency about covered benefits and provider networks. The ACA, however, does not require states to adopt policies that ensure continuity of providers or non-essential services when insurance coverage changes.
§1001, §1302, §1311 – Require the Secretary of HHS to define essential health benefits and standard explanation of coverage documents. States may choose to add additional required benefits.
§1311 – Requires health plans offered through Exchanges to inform consumers about provider networks and use standard formats for presenting benefit plans. Also requires state basic health programs to coordinate administration and benefits with Medicaid, CHIP, and other state-administered programs.
§2001 – Medicaid benchmark benefits for newly eligible beneficiaries must include the essential health benefits.less