Longitudinal assessment of state health agency billing practices

State and territorial health agencies (S/THAs) play a critical role in promoting and protecting health by performing a range of services for which S/THAs may bill.  The implementation of the Affordable Care Act (ACA) and the resulting increase in insured residents may have an impact on how and which payers are billed.  The current study’s goal is to examine the billing practices at S/THAs in 2014 and 2015.

The Association of State and Territorial Health Officials (ASTHO) conducted an online survey of all US state and territorial health agencies in 2014 to document emerging issues in the management, resources, and activities of S/THAs, including the impact of the implementation of the ACA.  The survey will be re-administered in February 2015.

In 2014, thirty-seven states, one territory, and one freely-associated state responded to the survey.  While S/THAs vary in the payers billed by type of service, respondents reported that they did not bill third-party payers for the majority of ten specific services surveyed on.  However, 59 percent of respondents indicated that they are engaged in efforts to increase billing for clinical services, and nearly half of respondents indicated that they are working to increase billing.  The results will be updated with longitudinal comparisons between the 2014 and 2015 data.

Though the implementation of the ACA has not yet demonstrated an impact on the billing practices of S/THAs in the areas studied, there may be future implications, including expanded billing of private insurers and changes in the types of services that S/THAs bill for.