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  • Medicaid and the ACA
    Medicaid and the ACA Medicaid and the ACA Patient Protection and Affordable Care Act= PPACA=Affordable ... to interface between the On June 28, 2012, the U.S. Supreme Court issued a deci- sion that while the ...

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    • Authors: Rebecca Owen
    • Date: Aug 2015
    • Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; External Forces & Industry Knowledge>Actuarial theory in business context; External Forces & Industry Knowledge>External forces and business performance
    • Topics: Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health information technology; Health & Disability>Health insurance; Health & Disability>Health risks; Health & Disability>Payment models; Health & Disability>Public financing - Health & Disability
  • The Medicare Advantage 5-Star Rating Program and Its Implications for Actuaries
    payment percentages by star rat- ing are shown in the table in Figure 1. The percentage of the savings a plan ... rebate percentages by star rating are shown in the table in Figure 2. Special rules apply to low-enrollment ...

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    • Authors: Adrian L Clark, Gabriela Dieguez, Bradley James Piper
    • Date: May 2012
    • Competency: External Forces & Industry Knowledge>External forces and business performance; Results-Oriented Solutions>Actionable recommendations; Strategic Insight and Integration>Strategy development; Technical Skills & Analytical Problem Solving>Problem analysis and definition
    • Publication Name: Health Watch
    • Topics: Health & Disability>Health insurance; Health & Disability>Payment models; Public Policy
  • A Regulatory Perspective on Rate Review Before and After the Affordable Care Act
    released separate guid- ance indicating that the U.S. Department of Health and Hu- man Services (HHS) ... eration of Independent Business v. Sebelius, the U.S. Supreme Court upheld two of the main provisions ...

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    • Authors: Annette James
    • Date: Aug 2015
    • Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; External Forces & Industry Knowledge>Actuarial theory in business context; External Forces & Industry Knowledge>External forces and business performance
    • Topics: Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health information technology; Health & Disability>Health insurance; Health & Disability>Health risks; Health & Disability>Payment models; Health & Disability>Public financing - Health & Disability
  • Selling Health Insurance Across State Lines
    implementation of the ACA. The ACA allows the U.S. Office of Personnel Management (OPM) to oversee ... of America, the District of Colum- bia and the U.S. Territories. 2 From Kaiser Health News: State coverage ...

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    • Authors: Lawrence Mitchell
    • Date: Aug 2017
    • Competency: External Forces & Industry Knowledge>External forces and business performance; Professional Values>Public interest representation; Strategic Insight and Integration>Big picture view; Strategic Insight and Integration>Influence decisions; Technical Skills & Analytical Problem Solving>Problem analysis and definition
    • Publication Name: In The Public Interest
    • Topics: Health & Disability>Health insurance; Public Policy
  • Use of Treatment Protocols to Manage Hospital Utilization at the Insurance Payer Level
    wanted this thing to go, get everybody around the table to agree on that, and then get everybody to play ... a small employer, they don't bring much to the table. When it comes to the network, the plan design ...

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    • Authors: Donna Kalin, Deborah Loveland, William E Mabe
    • Date: Jun 1998
    • Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; External Forces & Industry Knowledge>Actuarial theory in business context; External Forces & Industry Knowledge>External forces and business performance; Strategic Insight and Integration>Strategy development; Technical Skills & Analytical Problem Solving>Innovative solutions
    • Publication Name: Record of the Society of Actuaries
    • Topics: Economics>Health economics; Health & Disability>Chronic health management - Health & Disability; Health & Disability>Health care; Health & Disability>Health insurance