Wednesday, December 3, 2014

In Response to Complaints over the Ultra-Narrow Networks Spawned by Obamacare, New Rules Proposed

The National Association of Insurance Commissioners (NAIC) has released draft regulations regarding the adequacy of health plan provider networks including in the Exchanges set up under PPACA.  The new draft model act can be found here.

According to Employee Benefit News:
... CMS has stated it will revise its own network adequacy laws based on what the NAIC recommends.... 
“Accordingly, it is important for any insurer that utilizes provider networks and for the provider networks themselves to understand how these provisions may impact them.” 
The draft model law includes several changes to the existing NAIC model, most notably the use of the term “managed care plan” has been replaced by “network plan.” 
NAIC says in the draft that the term “is intentionally broad in order to apply to health benefit plans using any type of requirement or incentive for enrollees to choose certain providers over others, such as HMOs, EPOs, PPOs and including accountable care organizations (ACOs) and other models of health care delivery systems.” 
Some states may wish to limit the definition by regulation to exclude plans having broad-based provider networks that meet specified standards, the draft adds.  
While the model law has always required issuers to ensure and maintain adequate patient access to providers, the draft model law now includes a requirement for health plan issuers to submit access plans to state regulators. 
States are given the option to require approval of the access plan by the insurance commissioner, or simply require the access plan be filed with the state.

The draft model law also includes new criteria to be used in determining the sufficiency of a provider network, including geographic population dispersion and new health care options such as telehealth and telemedicine. Under the draft model law, network plans are also required to maintain an online provider directory and update it at least monthly. 
Print copies of provider directories must be available upon request, as well as accessible versions of the directories for individuals with disabilities or limited English language proficiency. 
The NAIC is accepting comments until Jan. 12, 2015, on the draft model law.