How three states are stepping up network adequacy oversight

Amid calls for more regulation triggered by narrowing health plan networks, three states in particular are scoring "victories" in the push to improve network adequacy and provider directories, according to consumer advocacy organization Families USA.

A post on the organization's blog describes the efforts of officials and advocates in Georgia, Maryland and Colorado, which build on the model law created by the National Association of Insurance Commissioners--a framework the federal government has urged states to adopt.

In Georgia, the post says, a coordinated effort spearheaded by the group Georgians for a Healthy Future resulted in a bill that draws upon the NAIC's recommendations in regulating narrow networks. The bill--which has passed the state House and Senate and is awaiting the governor's signature--includes provisions that require insurers to maintain accurate provider directories and provide clear information about tiered networks, among others.

Similarly, a bill in Maryland requires insurers to periodically review and update their provider directories and investigate reports of inaccuracies. It also requires the state insurance commissioner to adopt regulations before 2018 that include quantitative criteria to evaluate network adequacy.

The Colorado Division of Insurance, meanwhile, has been issuing bulletins to enact consumer protections related to network adequacy. The agency has finalized a bulletin that lays out standards for appointment wait times, travel distance, and provider-to-enrollee ratios by specialty or service type, and will soon finalize another one on provider directory standards.

Not all are convinced, however, that narrow networks adversely impact consumers. An executive from BlueCross BlueShield of Tennessee has argued that creating more focused networks helps keep down costs for consumers and insurers. And an analysis last fall found that in California, there's no significant relationship between raw network size and network performance.

To learn more:
- read the blog post

Related Articles:
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Analysis: Narrow networks don't sacrifice quality for cost
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