Are stricter network standards coming for exchange plans?


A think tank within the Department of Health and Human Services analyzed whether the agency should set new rules requiring stricter standards for provider networks on the health insurance exchanges, reported LifeHealthPro.

David Cusano, a senior research fellow at the Georgetown Health Policy Institute, said the HHS Assistant Secretary for Planning and Evaluation has been studying these issues when he spoke at a recent meeting of the National Association of Insurance Commissioners' Health Insurance and Managed Care Committee.

The new standards could be based on Medicare Advantage requirements for networks, Cusano told the state insurance regulators. Medicare Advantage mandates that plans offer a minimum number of providers and requires that members don't exceed a certain amount of travel time to see an in-network doctor or facility.

Cusano didn't say whether the changes relate to a policy that the Centers for Medicare & Medicaid Services proposed earlier this year. In a letter, CMS said it might require insurers selling exchange plans to broaden their provider networks to include 30 percent of essential community providers in their area--or risk being kicked out of the online marketplaces, FierceHealthPayer previously reported.

Current provider network standards under the Affordable Care Act are relatively loose for plans sold on the exchanges, although states and exchange officials can choose to put stricter requirements in place. States like Washington have implemented new rules requiring insurers incorporate certain adequacy standards in their provider networks, FierceHealthPayer previously reported. However, a recent study found that most states won't boost oversight of narrow networks.

To learn more:
- read the LifeHealthPro article

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