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

In a number of new engagements in states across the country, FAIR Health is continuing its tradition of supporting state health-related programs. 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 ground and air 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 trusted nationwide resource to advance state health-related programs.”