Support for State Laws and Initiatives

FAIR Health’s FH^® Benchmarks serve as official reference points for state consumer protection laws, reimbursement for emergency services and state health programs—an endorsement of our effective stewardship of the FAIR Health data repository; our neutrality; and the reliability and breadth of our benchmarks and the underlying claims data on which they are based.

Surprise Billing:

FAIR Health benchmarks are frequently used to support mandated reimbursement and/or dispute resolution programs under state surprise billing laws.

• California sets a specific FAIR Health benchmark as a ceiling on emergency department charges for low-income patients.
• Connecticut chose a specific FAIR Health benchmark as the standard for payment for out-of-network emergency services.
• Georgia contracted with FAIR Health to create a custom benchmark dataset for use by stakeholders in Georgia in the payment of out-of-network emergency and surprise bills.
• New Mexico selected a specific FAIR Health allowed benchmark as the surprise bill reimbursement rate, provided that no payment is less than 150 percent of the Medicare reimbursement rate.
• New York State identified FAIR Health’s 80th percentile charge benchmark as a guideline for disclosing plan rules on reimbursements and as one of the factors for consideration in independent dispute resolution regarding out-of-network emergency services and surprise out-of-network services at in-network facilities.
• Texas identified FAIR Health’s 80th percentile of billed charges and 50th percentile of allowed amounts as among the factors to be considered in arbitration of professional surprise bills.

FAIR Health has also provided data and technical assistance to officials addressing balance billing issues in over 20 states. Several states and plans offered through healthcare exchanges provide direct links to FAIR Health’s consumer site for their constituents and beneficiaries.

Workers' Compensation:

FAIR Health has assisted a number of states to develop and update their workers’ compensation fee schedules, including Arizona, Colorado, Georgia, Kentucky, Mississippi, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina and Tennessee. FAIR Health data also have been used for workers’ compensation programs in Alaska, Pennsylvania and Wisconsin..

Additional state uses of FAIR Health data and reliance on FAIR Health expertise include:

• Out-of-network claims pricing under the state health insurance plan (Alaska);
• Supporting the reimbursement of dental claims for disabled pediatric patients (Arizona);
• Supporting a study on ground and air ambulance services (Florida);
• Providing a customized benchmark product to support fee schedule development under a no-fault reform law (Michigan);
• Helping to develop and publish a vocational rehabilitation fee schedule for services to citizens with disabilities (New Hampshire);
• Providing an authorized personal injury protection (auto liability) reimbursement standard (New Jersey);
• Providing Medicaid program support and supporting a program establishing fair reimbursement for services rendered to neurologically impaired newborns (New York);
• Supporting comparative analyses as well as advocacy, transparency and consumer education efforts (Texas); and
• Helping to develop and update two fee schedules based on Medicare rates related to cancer prevention and cardiovascular health (Washington State).