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CMS to Allow States to Monitor Adequacy of Health Plan Network

March 15, 2016 // News

healtyh-centerThe Centers for Medicare & Medicaid took a step back from their proposed strict federal level regulation of the adequacy of health plan networks and instead will allow states the time to adopt a proposal from the National Association of Insurance Commissioners.

The NAIC proposal addresses the issue over narrowing network plans that are particularly of concern in rural and less populated areas. The goals of the proposed controls are to make sure that consumers do not lose access to affordable and quality healthcare. The NAIC s proposal has been approved by all states and its recommendations are expected to be implemented across the country within three years.

The NAIC proposal sets new standards to address a variety of concerns including: access to plans, provider directories and continuity of care, billing, and reviewing the adequacy of care based on ratios such as accessibility to providers.

Although consumers like the lower costs of the narrow-network, one issue is that people may go to the emergency room for non-emergencies because they can’t get local access to a provider. Long travel distances to a primary care physician also result in more ER visits.

In 2017, the out-of-pocket annual health care costs for individuals will increase to $7,150. For families, the increase climbs to $14,300.

In addition, anyone who attempts to enroll after the open enrollment date will find it harder to qualify and will be required to show proof of qualification.


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