network adequacy

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

Posted December 4, 2015 by CHIR Faculty

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.

The Next Big Thing in Network Adequacy: The NAIC Model Act

Posted October 19, 2015 by CHIR Faculty

In November, the National Association of Insurance Commissioners (NAIC) will finalize the Network Adequacy Model Act – a draft bill designed to be used by states to enact provider access standards for private health insurance plans. Consumer representative Claire McAndrew explores what the act includes as well as areas for improvement.

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

Posted September 8, 2015 by JoAnn Volk

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.

Telemedicine and its Effect on the Regulatory Landscape

Posted June 3, 2015 by CHIR Faculty

Some states are making policies related to the emergence of telemedicine or the delivery of health care services through telecommunication technology. While states are taking varying approaches, telemedicine can increase access to specialty services such as mental health services and help address network adequacy concerns. CHIR’s Sandy Ahn highlights some of the issues related to telemedicine.

New Proposed Rules for Network Adequacy for Medicaid Managed Care Plans – Lessons Learned from Medicare & the Marketplaces

Posted May 29, 2015 by

The Centers for Medicare and Medicaid Services (CMS) recently released draft regulations governing Medicaid managed care plans. In setting standards for network adequacy, the agency looked to both the Medicare Advantage program and the health insurance marketplaces created under the Affordable Care Act. Sabrina Corlette examines approaches to ensuring adequate plan networks across the three programs.

Implementing the Affordable Care Act: State Regulation of Marketplace Plan Provider Networks

Posted May 5, 2015 by Justin Giovannelli

Narrow network plans were common on the health insurance marketplaces in 2014. In a new issue brief for The Commonwealth Fund, CHIR researchers examine the standards states had in place to regulate plans’ provider networks in the first year of marketplace coverage and describe how states revisited their rules for year two.

New Georgetown Report: Assessing Consumers’ Experience with ACA Coverage through the Eyes of State Consumer Assistance Programs

Posted April 10, 2015 by

While the ACA has successfully resulted in 16.4 million newly insured people, we don’t yet know a lot about how that new coverage is working for them. However, state consumer assistance programs (CAPs) have the eyes and ears on the ground to help identify problems or gaps in private insurance coverage. Georgetown researchers surveyed 10 state CAPs and found many common issues for consumers’ coverage experiences, pre- and post-ACA.

While All Eyes Are On Upcoming SCOTUS Decision, NAIC Work Continues

Posted April 3, 2015 by JoAnn Volk

The NAIC Spring meeting tackled a number of ACA implementation issues important to consumers. JoAnn Volk shares some highlights from the meeting.

Health Plan Narrow Networks: Highlighting Transparency Deficiencies for Consumers

Posted March 20, 2015 by

A recent conference hosted by the Robert Wood Johnson Foundation on health system transparency allowed a diverse group of stakeholders – state and federal regulators, an insurance industry executive, a provider, and CHIR’s own Sabrina Corlette to discuss how the emergence of narrow provider networks on the Affordable Care Act’s marketplaces has spotlighted deficiencies in the information available for consumers to make good plan choices. Sabrina Corlette shares some of the issues debated and discussed.

New Report on States’ Oversight of Health Plan Network Adequacy

Posted November 18, 2014 by

The consumer representatives to the National Association of Insurance Commissioners (NAIC) released a report this week on state approaches to regulating and monitoring the adequacy of health plan provider networks. Sabrina Corlette provides this overview.