Legislation
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Effective Date
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1332 Waiver
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Funding Source
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Program run by or to be run by (gov, insurers, others?)
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Markets
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Carrier participation - voluntary or mandatory?
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Provider Participation
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Provider reimbursement
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Are there regional exclusions on provider payments?
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Plans already available in 2021, changes expected in 2023.
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Federal and state-funded subsidies via ACA PTCs and 1332 innovation waiver.
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Government (Medicaid)
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Individual
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Voluntary. Medicaid MCOs must submit “good faith” bids to administer public option plans. Other carriers may submit bids as well.
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Provider rates in aggregate must be comparable to or better than Medicare rates, inclusive of add-on payments or subsidies; alternative approaches set for certain providers.
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Reimbursement rates capped at 160% of Medicare.
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The reimbursement rates for a federally qualified health center or a rural health clinic under the Nevada Public Option must be comparable to or better than the reimbursement rates established for patient encounters under the applicable Prospective Payment System established for Medicare.
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