Health insurance: Council on Medical Service reports

These council reports have proposed strategies to address health insurer actions that interfere with the patient/physician relationship and impact the practice of medicine. Such topics include prior authorization, covered benefits, and affordability of health insurance.

• Requiring Payment for Physician Signatures (PDF) CMS Report 4-A-25
• Minimum Requirements for Medication Formularies CMS Report 9-A-25

• Sustainable Payment for Community Practices (PDF) CMS Report 8-A-24

• Health Insurers and Collection of Co-pays and Deductibles (PDF) CMS Report 2-I-23
• Strengthening Network Adequacy (PDF) CMS Report 3-I-23
• Medicare Coverage of Dental, Vision and Hearing (PDF) CMS Report 02-A-23
• Private Insurer Payment Integrity (PDF) CMS Report 03-A-23
• Health Care Marketplace Plan Selection (PDF) CMS Report 06-A-23
• Reporting Multiple Services Performed During a Single Patient Encounter (PDF) CMS Report 07-A-23

• Reducing Inequities and Improving Access to Insurance for Maternal Health Care (PDF) CMS-CSAPH joint report N-21
• Access to Health Plan Information regarding Lower-Cost Prescription Options (PDF) CMS Report 2-N-21
• Covering the Remaining Uninsured (PDF) CMS Report 3-N-21
• Financing of Home and Community-Based Services (PDF) CMS Report 4-N-21
• Promoting Accountability in Prior Authorization (PDF) CMS Report 04-JUN-21

• Options to Maximize Coverage Under the AMA Proposal for Reform (PDF) CMS Report 1-November 2020
• Mitigating the Negative Effects of High-Deductible Health Plans (PDF) CMS Report 2-November 2020. Read the issue brief for this report: Mitigating Negative Impacts of High-Deductible Health Plans (PDF).
• Health Plan Initiatives Addressing Social Determinants of Health (PDF) CMS Report 7-November 2020

• Addressing Financial Incentives to Shop for Lower-Cost Health Care (PDF) CMS report 2-I-19
• Established Patient Relationships and Telemedicine (PDF) CMS report 1-I-19
• Health Plan Payment of Patient Cost-Sharing (PDF) CMS report 9-A-19

• Aligning Clinical and Financial Incentives for High-Value Care (PDF) CMS/CSAPH joint report I-18. Read the issue briefs for this report: Promoting Access to High-Value Care (PDF) and Value-Based Insurance Design (PDF).
• Air Ambulance Regulations and Payments (PDF) CMS report 2-I-18
• Coverage for Colorectal Cancer Screening (PDF) CMS/CSAPH joint report A-18
• Improving Affordability In the Health Insurance Exchanges (PDF) CMS report 2-A-18. Read the issue briefs for this report: Improving Health Insurance Affordability (PDF), Taking Steps forward to Cover the Uninsured (PDF), and Using Reinsurance to Stabilize and Strengthen the Individual Market (PDF).
• Ensuring Marketplace Competition and Health Plan Choice (PDF) CMS report 3-A-18. Read the issue briefs for this report: Improving Health Insurance Affordability (PDF) and Taking Steps forward to Cover the Uninsured (PDF).
• Health Plans’ Medical Advice (PDF) CMS report 4-A-18
• Financing of Long-Term Services and Supports (PDF) CMS report 5-A-18. Read the issue brief for this report: Financing of Long-Term Services and Supports (PDF).
• Insulin Affordability (PDF) CMS report 7-A-18

• Ensuring Continuity of Care Protections During Active Courses of Treatment (PDF) CMS report 3-A-17
• Expansion of U.S. Veterans’ Health Care Choices (PDF) CMS report 6-A-17
• Health Care Financing Models (PDF) CMS report 2-A-17
• Prior Authorization and Utilization Management Reform (PDF) CMS report 8-A-17
• Retail Health Clinics (PDF) CMS report 7-A-17
• Value of Preventive Services (PDF) CMS/CSAPH joint report A-17. Read the issue briefs for this report: Promoting Access to High-Value Care (PDF) and Value-Based Insurance Design (PDF).
• Affordable Care Act Section 1332 Waivers (PDF) CMS report 1-I-17. Read the issue briefs for this report: Improving Health Insurance Affordability (PDF) and Taking Steps forward to Cover the Uninsured (PDF).
• Health Insurance Affordability: Essential Health Benefits and Subsidizing the Coverage of High-Risk Patients (PDF) CMS report 4-I-17. Read the issue briefs for this report: Improving Health Insurance Affordability (PDF), Taking Steps forward to Cover the Uninsured (PDF), and Using Reinsurance to Stabilize and Strengthen the Individual Market (PDF).

• Affordable Care Act Medicaid Expansion (PDF) CMS report 2-A-16. Read the issue brief for this report: Taking Steps forward to Cover the Uninsured (PDF).
• Access to Self-Administered Medications (PDF) CMS report 4-A-16
• Prior Authorization Simplification and Standardization (PDF) CMS report 7-A-16
• Infertility Benefits for Veterans (PDF) CMS report 1-I-16

• Price Transparency (PDF) CMS report 4-A-15. Read the issue brief for this report: Price Transparency (PDF).
• Integrating Physical and Behavioral Health Care (PDF) CMS report 6-A-15
• Coverage for Chronic Pain Management (PDF) CMS/CSAPH joint report -A-15
• Hearing Aid Coverage (PDF) CMS report 6-I-15
• Health Insurance Affordability (PDF) CMS report 8-I-15. Read the issue briefs for this report: Improving Health Insurance Affordability (PDF) and Taking Steps forward to Cover the Uninsured (PDF).

• Health Insurer Code of Conduct Principles (PDF) CMS report 5-A-14
• Improving the Affordable Care Act (PDF) CMS report 9-A-14
• Privacy Issues Regarding Insurance Company Explanation of Benefits (PDF) CMS report 2-I-14
• Reference Pricing (PDF) CMS report 3-I-14
• Network Adequacy (PDF) CMS report 4-I-14
• The Future of Employer-Sponsored Insurance (PDF) CMS report 6-I-14
• Modernizing TRICARE Payment Policies (PDF) CMS report 8-I-14

• Worksite Health Clinics (PDF) CMS report 1-A-13
• Value-Based Insurance Design (PDF) CMS report 2-A-13. Read the issue briefs for this report: Promoting Access to High-Value Care (PDF) and Value-Based Insurance Design (PDF).
• Medical Record and reporting Standardization Update (PDF) CMS report 2-I-13
• Monitoring the Affordable Care Act (PDF) CMS report 5-I-13

• Basic Health Program (PDF) CMS report 5-A-12
• Small Businesses and Health Reform (PDF) CMS report 6-A-12

• Essential Health Care Benefits (PDF) CMS report 2-A-11
• Covering the Uninsured and Individual Responsibility (PDF) CMS report 9-A-11
• Administrative Simplification In the Physician Practice (PDF) CMS report 8-I-11

• Radiology Benefits Managers (PDF) CMS report 5-I-09

• Medical Care Outside the United States (PDF) CMS report 1-A-08
• The Role of Cash Payments in All Physician Practices (PDF) CMS report 3-A-08
• Value-Based Decision-Making in the Health Care System (PDF) CMS report 7-A-08
• Acceptance of TRICARE Health Insurance (PDF) CMS report 2-I-08

• Adequacy of Health Insurance Coverage Options (PDF) CMS report 7-A-07
• Cost-Sharing Arrangements for Prescription Drugs (PDF) CMS report 1-I-07

Access all council reports prior to 2007 or learn more about the Council on Medical Service.