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CMS plans network-breadth rating system for Healthcare.gov plans


Although the federal government has stepped back from its proposal to implement additional network adequacy regulations for Affordable Care Act plans, it will move forward with its initiative to provide Healthcare.gov shoppers with information about health plans' network breadth.

The Centers for Medicare & Medicaid Services' proposed 2017 Notice of Benefit and Payment Parameters had outlined its idea to rate qualified health plans' (QHPs) network coverage by comparing their provider network information to other QHPs. CMS would then place plans into one of three categories based on network size, and make this information available to shoppers on the federal exchange to guide their plan choices.

In its final rule, the agency reiterates that "we plan to proceed with providing information about each QHP's relative network breadth on Healthcare.gov."

Though some public comments on its proposal supported such a network-breadth rating system, some raised concerns that it would be confusing because it does not factor in quality, CMS points out. Others, it says, requested that both physicians and hospitals be included in a rating system.

In response, CMS says it is conducting consumer testing to decide how to display the ratings in the most helpful way, and adds it will provide more details about what specialties the ratings will include in its 2017 Final Letter to Issuers and in the QHP certification instructions. The agency hopes to implement its proposal in time for 2017 open enrollment.

CMS' proposed rule also sought to require states to adopt specific network adequacy standards, but as insurers were highly critical of this provision, the agency said in its final rule that it will instead "defer to the expertise of state insurance regulators on network adequacy." CMS added, though, that it expects states to "actively implement" the National Association of Insurance Commissioners' draft of a model state law that sets network adequacy standards.

The issue of network adequacy has caught the attention of regulators and consumer advocates alike as narrow-network plans become more common on the ACA exchanges. A study published in October also raised alarm when it found that as many as 14 percent on plans on the federal exchange lack physicians in at least one common specialty.

To learn more:
- read the final rule

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