FAIR Health Data and Expertise Selected to Support State Health-Related Programs across the Country

New Engagements in New Mexico, Oklahoma, Washington State and New Hampshire

News provided by

Oct 15, 2019, 06:43 ET

NEW YORK, Oct. 15, 2019 /PRNewswire/ -- In a number of new engagements in states across the country, FAIR Health is continuing its tradition of supporting state health-related programs. A national, independent nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information, FAIR Health has recently added the following relationships to its state activities:

New Mexico. Pursuant to a Request for Information (RFI) process, FAIR Health was selected by the state's Office of Superintendent of Insurance (OSI) to provide claims data for the surprise bill reimbursement rate established under New Mexico's Surprise Billing Protection Act, effective January 1, 2020. The Act sets a reimbursement rate for surprise medical bills at the 60th percentile of the allowed rate as reported in a benchmarking database maintained by a nonprofit organization specified by the Superintendent of Insurance, provided that no payment is less than 150 percent of the Medicare reimbursement rate. The nonprofit organization, which must be conflict-free and unaffiliated with any healthcare stakeholder, was named by OSI as FAIR Health. New Mexico adds to a growing list of other jurisdictions turning to FAIR Health data to support their surprise billing initiatives.
Oklahoma. Following a competitive bidding process, Oklahoma awarded FAIR Health the contract to review, study and assist development of the state's workers' compensation fee schedule and update it with new codes. The new fee schedule will be effective in 2020.
Washington State. In another procurement process, the state of Washington awarded FAIR Health a 10-year contract to help develop and update two fee schedules based on Medicare rates related to cancer prevention and cardiovascular health. The fee schedules are for two public health programs—the Breast, Cervical and Colon Health Program (BCCHP) and WISEWOMAN program—that cover the cost of a select set of clinical services to ensure access to cancer screening, diagnostic procedures and cardiovascular risk reduction services for uninsured and underinsured individuals.
New Hampshire. After submitting a response to a Request for Proposals (RFP), FAIR Health was selected by New Hampshire to help develop and publish a schedule of reasonable reimbursement fees for the New Hampshire Department of Education Bureau of Vocational Rehabilitation (NHVR). NHVR provides rehabilitation services to New Hampshire citizens with disabilities, with the goal of enabling them to secure employment as well as financial and personal independence.

The new engagements are additions to the ongoing work FAIR Health is doing for states across the country in support of health-related programs. FAIR Health data are referenced in statutes, regulations and official memoranda as the designated source of cost information for a variety of state health-related programs. In addition to the listed programs, FAIR Health helps develop and update workers' compensation fee schedules for Colorado, Georgia, Kentucky and Mississippi. In other assignments, FAIR Health provides a broad range of data and assistance to states, from supplying benchmarks that serve as standards for payment under various laws and regulations, to helping evaluate economic and clinical trends and to supporting research with data and analytics for topics ranging from opioid costs to ambulance rates to the impact of changes in public policies. For more details, see FAIR Health's web page on its role as an official data source.

FAIR Health President Robin Gelburd commented: "We are pleased to be able to provide current, comprehensive data and expertise to help states meet the needs of their constituents. Given the richness and independence of the data collection, FAIR Health has come to serve as a critical nationwide resource to advance state health-related programs."

About FAIR Health
FAIR Health is a national, independent nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information through data products, consumer resources and health systems research support. FAIR Health possesses the nation's largest collection of private healthcare claims data, which includes over 29 billion claim records contributed by payors and administrators who insure or process claims for private insurance plans covering more than 150 million individuals. FAIR Health licenses its privately billed data and data products—including benchmark modules, data visualizations, custom analytics and market indices—to commercial insurers and self-insurers, employers, providers, hospitals and healthcare systems, government agencies, researchers and others. Certified by the Centers for Medicare & Medicaid Services (CMS) as a national Qualified Entity, FAIR Health also receives data representing the experience of all individuals enrolled in traditional Medicare Parts A, B and D; FAIR Health houses data on Medicare Advantage enrollees in its private claims data repository. FAIR Health can produce insightful analytic reports and data products based on combined Medicare and commercial claims data for government, providers, payors and other authorized users. FAIR Health's systems for processing and storing protected health information have earned HITRUST CSF certification and achieved AICPA SOC 2 compliance by meeting the rigorous data security requirements of these standards. As a testament to the reliability and objectivity of FAIR Health data, the data have been incorporated in statutes and regulations around the country and designated as the official, neutral data source for a variety of state health programs, including workers' compensation and personal injury protection (PIP) programs. FAIR Health data serve as an official reference point in support of certain state balance billing laws that protect consumers against bills for surprise out-of-network and emergency services. FAIR Health also uses its database to power a free consumer website available in English and Spanish and an English/Spanish mobile app, which enable consumers to estimate and plan for their healthcare expenditures and offer a rich educational platform on health insurance. The website has been honored by the White House Summit on Smart Disclosure, the Agency for Healthcare Research and Quality (AHRQ), URAC, the eHealthcare Leadership Awards, appPicker, Employee Benefit News and Kiplinger's Personal Finance. FAIR Health also is named a top resource for patients in Elisabeth Rosenthal's book An American Sickness: How Healthcare Became Big Business and How You Can Take It Back. For more information on FAIR Health, visit fairhealth.org.

Contact:
Dean Sicoli
Executive Director of Communications and Government Relations
FAIR Health
646-664-1645
[email protected]

SOURCE FAIR Health