CMS Responds to Network Adequacy Concerns

Federal regulators are trying to set expectations and a tentative schedule for public exchange plans in 2015; they're also proposing a new approach to network adequacy and essential community providers, after complaints from consumers and providers in a few markets.

Federal regulators are trying to set expectations and a tentative schedule for public exchange plans in 2015; they're also proposing a new approach to network adequacy and essential community providers, after complaints from consumers and providers in a few markets.

The last date to submit health plans for certification through either the state or federal rate review system will be Sept. 4, which will allow time for multiple rounds of applications and resubmission before certification is finalized Oct. 17, the Center for Consumer Information and Insurance Oversight wrote in a summary of various proposed and final rules.

Regardless of what state they’re selling in, insurers may have some new information to submit to the Centers for Medicare & Medicaid Services this summer. Regulators said they’re going to be asking for lists of all in-network and out-of-network hospitals, primary care, mental health and oncology providers, and determine whether they offer patients “reasonable access” in their service area.

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Source: Healthcare Payer News