Noteworthy News

CMS Seeks to Shape Provider Networks

Insurers offering qualified health plans in the federally facilitated marketplace will soon be required to meet federal standards for the adequacy and breadth of their provider networks.

According to a letter issued by the Centers for Medicare & Medicaid Services (CMS) to insurers, the agency will seek to require qualified health plans to include in their provider networks at least 30 percent of the essential community providers in the region the plan serves and at least one of each type of essential community provider.

cmsEssential community providers include disproportionate share  hospitals, children’s hospitals, sole-community hospitals, rural referral centers, critical access hospitals, federally qualified health centers, and others.

If implemented, such a requirement could benefit many urban safety-net hospitals, which are all disproportionate share hospitals.

CMS has published a letter to insurers outlining its plans; find that letter here.  It also is soliciting input on its proposed approach, with interested parties invited to submit comments by February 25.

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