CMS Finalizes 2015 Qualified Health Plan Criteria
The federal Centers for Medicare & Medicaid Services (CMS) has issued a letter to insurers describing the provider networks insurers will need to be certified as qualified health plans in the federally facilitated marketplace in 2015.
The final criteria emphasize creating networks that include providers that can help insured members obtain mental health and substance abuse services. Insurers also will be required to include at least 30 percent of the “essential community providers” located in their area within their provider networks. Essential community providers include critical access hospitals, federally qualified health centers (FQHCs), children’s hospitals, and others.
Among those essential community providers are disproportionate share hospitals – a vital consideration for NAUH and urban safety-net hospitals, all of which are disproportionate share hospitals.
See CMS’s final letter to insurers on qualified health plan criteria here.