Quality Over Quantity? New Medicaid Network Adequacy Rules Illuminate Disparities Among Insurance Program Standards

Narrow network plans, or plans with a limited network of providers, present problems for consumers across the various coverage programs. In May, the Centers for Medicare & Medicaid Services released the final rule setting network adequacy standards for Medicaid and CHIP managed care plans. The new rule requires states to set quantitative standards for network adequacy; but since these standards don’t apply uniformly to other federal programs, network adequacy – and access to essential health services – varies greatly for consumers based on what program they fall under. Continue reading

Telemedicine: Another Tool in the Toolkit to Meet Network Adequacy Standards?

Health plans have been increasingly narrowing their provider networks, raising concerns about gaps in access to services for consumers, particularly in areas with provider shortages. Could telemedicine be used to help fill those gaps? CHIR authors say not yet and summarizes key findings from a new report published in partnership with the Urban Institute and with funding from the Robert Wood Johnson Foundation. Continue reading

Georgetown Experts Help States Weigh Solutions to Protect Consumers from Unexpected Medical Bills

As reports of patient encounters with unexpected provider bills continue to make headlines, state and federal policymakers are working to find solutions to the problem of surprise out-of-network billing. A recent Georgetown report on the issue caught the eye of two states – Pennsylvania and Florida – that are attempting to set new standards to protect consumers from balance bills. CHIR’s Ashley Williams shares a summary of what these states heard from our report’s lead authors. Continue reading

The NAIC’s Summer Meeting: Updating Network adequacy and ACA Transparency Requirements

The National Association of Insurance Commissioners (NAIC) has been hard at work updating a model state law governing the adequacy of health plan provider networks and revising the ACA-mandated summary of benefits of coverage for consumers. JoAnn Volk serves as a consumer representative to the NAIC and shares details from their recent national meeting as well as upcoming activities. Continue reading