Understanding and implementing the Affordable Care Act and other new regulations while keeping a lid on costs and ensuring that all citizens have access to affordable, quality health care coverage is a constant challenge. Our team can help your insurance department navigate the ever-changing policy landscape with confidence.
ACA compliance and implementation
PCG brings extensive policy expertise and operational experience to help you manage your insurance plans in compliance with the ACA. Our services start with policy development and plan review and continue through ongoing management. We are an established leader in network adequacy compliance, helping our clients ensure the review process is federally compliant and automating what has historically been a manual process.
As the commercial insurance marketplace continues to evolve, insurance departments are trying to identify issues in carrier-provider contracts that could be driving medical expense growth and affecting their state's ability to monitor and regulate rate increases. PCG can assist with comprehensive reviews, informed by our broader rate review work.
Consumer Protection Grant
The Affordable Care Act includes key provisions aimed at protecting consumers and eliminating discriminatory practices by health insurance plans, especially individuals with chronic and potentially costly conditions. Since 2011, PCG has developed and implemented sustainable DOI processes, checklists, data collections and review tools to support state enforcement of ACA market reforms, including Benchmark Plan coverage and Preventive services requirements; discriminatory benefit and plan design, mental health parity, network adequacy/access and consumer appeals processes.
Healthcare Access and Markets
States regulate their private insurance markets and operate Medicaid managed care and fee-for-service programs to assure healthcare access to residents. This includes access to both physical and behavioral healthcare. States turn to PCG to organize their commercial health insurance regulatory compliance.
The Affordable Care Act and recently proposed federal regulations require greater transparency and justification for significant rate increases as regulators endeavor to ensure both reasonable rates and sufficient capitalization of insurance plans to meet claims payment obligations. Our team’s subject matter expertise and deep understanding of state insurance department practices can help you enhance your overall rate review program and successfully meet these obligations.
Regulatory support services
Our legal and policy experts can guide you through changes and updates to health coverage regulations, keeping you fully informed of the latest developments and helping you understand their impact.