Health Policy News Early Fall 2017

We hope that you enjoyed a restful and relaxing end to your summer, returning energized for what is looking like a busy legislative and regulatory season. We held this edition of Health Policy News for the final outcome of the Congressional push to make changes to the Affordable Care Act (ACA) by the September 30th expiration of the budget reconciliation instructions. As the month closed, neither a repeal package nor a stabilization package had advanced. However, immediate efforts on a stabilization bill continue, as do efforts to reauthorize the Children’s Health Insurance Program.

In contrast, there continues to be a flurry of state activity related to Section 1332 State Innovation Waivers. We have included the latest developments from our subject matter experts as well as an updated version PCG’s Section 1332 report. Also in this month’s edition, as many states approach the start of a new legislative cycle, we share a new PCG report on state efforts to protect consumers from balance billing . Below you’ll find a link to this report, which includes a legislative tracking tool cataloging efforts underway in a variety of states.

The next few issues of Health Policy News will feature educational content for readers. Our goal is to introduce a variety of methods by which states can further improve the operational, fiscal, and/or delivery of both commercial insurance and public health programs. This month, we share an educational video on the foundations of public assistance Cost Allocation Plans (CAPs).

As always, you can contact us at for more information on any of these pieces.

Developments in Section 1332 State Innovation Waivers

Progress has continued on state efforts to secure Section 1332 State Innovation Waivers.  Oregon submitted a waiver application at the end of August, seeking support for a state-based reinsurance program, and that application has since been determined complete. Iowa submitted two recent updates to its pending waiver application, which it initially submitted in June. Its waiver application has also now been determined complete. Despite recent reports that the waiver will be denied, a federal public comment and review are still pending.

While those states await decisions on their applications, at the end of September, Minnesota received approval of its Section 1332 Waiver application that it submitted in May.

Oklahoma also submitted a request for a Section 1332 Waiver in August but later withdrew that request.

Click here to continue reading about these waiver developments and to access PCG’s updated report of Section 1332 Waiver actions by states.

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Balance billing – a new report on recent efforts by states

With insights from insurance regulators and industry experts, PCG is releasing new report on the topic of balance billing, entitled “Balance Billing: Report of Recent Efforts to Protect Consumers.” Our goal is to provide a resource for states as they think through the options that may work best in their state, while balancing the interests of consumers, insurance carriers, providers and health care facilities.

Click here to continue reading about balance billing and to view the full report.

We urge regulators, legislators or health policy staff to reference the national models and legislative tracking we highlight, as well as contact us with any questions or concerns at

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What is a CAP all about?

PCG’s Cost Allocation team recently created an educational video to illustrate the foundations of public assistance CAP.  The video touches upon frequently asked questions, common assumptions, and requirements under the Social Security Act and Code of Federal Regulations, we hope in a humorous and engaging manner.

Click here to watch the video

This video is intended for all audiences seeking an understanding of what a CAP is, what a CAP is not, how it works, and how cost allocation plans benefit an agency. For more information about PCG’s cost allocation services, please contact Amy Ferraro at

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We want to hear from you!

Please do not hesitate to contact us with any questions or requests for additional information.  Also, if you have suggestions or feedback related to the newsletter, please let us know. Contact us today at

PCG helps state and local health agencies achieve their performance goals. Our seasoned professionals and proven solutions help agencies to increase program revenue, cut costs, and improve compliance with state and federal regulations. From behavioral health cost reporting to public hospital rate setting, PCG offers a wide array of consulting services to help state and local health agencies operate more efficiently and improve service to the populations they serve. To learn more, visit

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