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New Provider Network Mandate May Threaten Insurance Exchanges
The Centers for Medicare & Medicaid Services' proposal to mandate broader provider networks in public insurance exchanges could have the unintended consequence of discouraging insurer participation, according to analysts at Moody's.
The Centers for Medicare & Medicaid Services' proposal to mandate broader provider networks in public insurance exchanges could have the unintended consequence of discouraging insurer participation, according to analysts at Moody's.
After concerns in states like New Hampshire and Maine over some providers being left out of plans available in new insurance exchanges, CMS is proposing a new set of network adequacy standards for 2015. Depending on how broad the requirements end up, they could be counterproductive to the goal of using high-quality provider networks to control costs, argue Moody’s senior vice president Lisa Martin and public finance managing director Kendra Smith in a new briefing.
Under the proposal, first outlined in a summary of various proposed and final rules in early February, CMS would ask insurers selling qualified health plans for lists of all in-network and out-of-network hospitals, primary care, mental health and oncology providers to measure whether they offer patients “reasonable access” in their service areas. For essential community providers, CMS regulators are proposing extending the percentage required in a service area from 20 percent with to 30 percent, with limited exceptions.
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Source: Healthcare Payer News
What We’re Reading: Abortion Privacy Rules; Alzheimer Drug Hurdles; Nursing Home Staffing Overhaul
April 23rd 2024New health privacy rules aim to protect patients and providers in an evolving abortion landscape; some physicians express concerns about efficacy, risks, and entrenched beliefs in treating Alzheimer disease; CMS addresses longstanding staffing deficits in nursing homes.
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Navigating Health Policy in an Election Year: Insights From Dr Dennis Scanlon
April 2nd 2024On this episode of Managed Care Cast, we're talking with Dennis Scanlon, PhD, the editor in chief of The American Journal of Accountable Care®, about prior authorization, price transparency, the impact of health policy on the upcoming election, and more.
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Exploring Medicare Advantage Prior Authorization Variations
March 26th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the March 2024 issue of The American Journal of Managed Care® about their findings on variations in prior authorization use across Medicare Advantage plans.
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