To help family planning centers, HHS would like these studies to find ways the clinics can deliver "services confidentially while being able to bill insurance for the visit," which would likely require suppression of EOBs and claims history:
Title X centers regularly forego billing for clients that request confidential services. They are generally unable to negotiate EOB and claims history suppression with issuers because of State laws and regulations. OPA [Office of Population Affairs] is requesting case studies and other qualitative data to identify mechanisms where Title X providers have successfully provided services confidentially while being able to bill insurance for the visit. The specific regulatory issues are not well understood and potential solutions have not been identified.
HHS is also looking for these studies to provide the following:
- An analysis of statutes, regulations, or other policies (such as issuer or provider policies) across the U.S. that affect the ability of Title X providers to bill insurance when services are requested confidentially. Such an analysis should discuss both challenges as well as potential policies that could serve as best practices.
- An analysis of successful business practices (such as contract negotiations) or issuer policies, business practices or other mechanisms that have resulted in the ability of centers to successfully bill insurance while maintaining client confidentiality.
- If “best practices” are located as part of the study, provide an evaluation of the impact to the Title X center’s revenue as a result of the practice.
- Based on the findings of the initial case studies, an intervention to test whether solutions (or “best practices”) can be implemented at other centers and an evaluation of such implementation in terms of the impact to revenue. Applicants should propose a methodology for an intervention.
Grant applications from public or non-profit private entities interested in doing the studies are due by April 24, 2014. Awards will be from $250,000 to $400,000 per year, and may be approved for a project extending up to three years, depending on the availability of grant funds in future years.