Network adequacy oversight poised to take center stage


As insurers use narrow networks to control costs, federal regulators are poised to take on more oversight to ensure network adequacy if states fail to take the reins, according to a Health Affairs policy brief.

Consumer advocacy groups continue to butt heads with the insurance industry regarding increasingly narrow networks, and have pushed for more rigorous regulatory oversight. Given the fact that states vary considerably in their approach to evaluating network adequacy--using both quantitative and qualitative metrics--policy experts expect network adequacy controls will take center stage in the coming years.

Although no formal regulations have been passed, the federal government has clearly taken notice of network adequacy concerns. Earlier this year, the Centers for Medicare & Medicaid Services tabled a proposed rule in which the agency would have used quantitative metrics to evaluate “reasonable access” to care, instead allowing individual states to perform their own evaluations.

The National Association of Insurance Commissioners (NAIC) said it hopes to have all states adopt its updated qualitative network adequacy model within the next three years.

Three states have already taken steps to adopt the NAIC’s new model, but policy experts note that if the remaining states fail to comply, it’s likely the federal government will intervene with its own network adequacy controls. After all, federal officials already use quantitative standards to evaluate Medicare Advantage plan networks and will require numeric measures for the Medicaid managed care market beginning in 2018.

- read the Health Affairs policy brief