Feds Seek to Regulate Narrow Networks
Amid concerns that low-cost health plans are reducing their provider networks to contain costs at the expense of access to care for their members, the Centers for Medicare & Medicaid Services (CMS) is proposing new guidelines to limit how much those provider networks can be narrowed.
According to a CMS fact sheet,
To protect consumer access to health care providers and delivery organizations, the proposal asks states to establish a provider network adequacy standard for health plans in the federal Marketplace, subject to minimum criteria that CMS will establish at a later date, with a default time and distance standard otherwise. CMS is evaluating additional efforts to support transparency and informed consumer decision-making as it relates to provider network adequacy, and is requesting comment on whether designated network strength – for instance, indicating whether a plan has a broad number of doctors or health facilities in their network to choose from or not – could improve the consumer experience in future years.
…count certain out-of-pocket expenses on unexpected out-of-network services towards a policy holder’s annual out-of-pocket maximum, if the service was performed at an in-network facility and advance notice was not provided.
For a closer look at these proposals and others that are part of CMS’s proposed improvements for the 2017 federal insurance market, see this CMS news release; this CMS fact sheet; and the proposed regulation itself. Interested parties have until December 21 to submit comments on CMS’s proposed regulation.