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Insurance commissioners propose more narrow-network controls

Regulators unveil model law for states that increases consumer protections

In response to concerns about the rise of narrow-network health plans, the National Association of Insurance Commissioners (NAIC) has proposed new regulations to ensure that the trend doesn't harm consumers' access to affordable, quality care.

The insurance commissioners have been working to create a new model network adequacy law for states, noting the need for greater oversight as narrow-network plans became increasingly common on the Affordable Care Act exchanges. Indeed, a recent study revealed that as many as 14 percent of health plans on the federal exchange have networks that lack physicians in at least one common specialty.

Now the NAIC's effort has resulted in proposed revisions to the Managed Care Plan Network Adequacy Model Act, and includes proposals such as requiring insurers and providers to advise patients of the costs associated with choosing out-of-network providers and requiring insurers to update their provider directories once per month.

If a patient picks an out-of-network provider, the group's Health Insurance and Managed Care Committee proposes that consumers shouldn't have to pick up the extra cost. Instead, providers and insurers would settle the discrepancy in a mediation process.

In considering overall network sufficiency, NAIC says it would weigh factors including appointment waiting times, health plans' ability to meet the needs of low-income individuals and those with chronic conditions, providers' geographic accessibility, the availability of delivery options such as telemedicine, and provider-covered person ratios by specialty, among others.

The NAIC's proposals are a positive step, according to a letter of comment from provider, state, consumer and other nonprofit groups, but could do even more to protect consumers. The groups call for a clear set of quantitative standards to measure network adequacy, arguing that "the current model act provides these measures as an option for states, rather than a requirement."

They also ask for stronger controls on tired networks, requesting NAIC apply all network adequacy standards to the lowest cost-sharing tier of any such network. Tiered networks are a hot topic of late, especially as Horizon Blue Cross Blue Shield of New Jersey's new Omnia Health Alliance has come under fire by providers in the state.

To learn more:
- here's the proposed revisions
- check out the comment letter

Related Articles:
State insurance regulators take on narrow-network debate
Study finds some marketplace health plans lack network doctors in key specialties
AHIP: Out-of-network bills vary greatly nationwide
Number of narrow-network plans varies widely by state