States played key role in enforcing network standards in 2014

Some say health plans with narrow networks negatively impact consumers' access to quality care. While the Affordable Care Act established network requirements for plans in the commercial marketplaces, states played a role in both setting and enforcing such standards in 2014, according to the Commonwealth Fund.  

The brief examined various network adequacy standards in marketplace plans in all 50 states and the District of Columbia for the 2014 coverage year. Here's what the Commonwealth Fund found:

  • Twenty-one states established qualitative standards to assess the adequacy of plans' provider networks. Maryland, for instance, mandated that insurers maintain a panel of in-network providers that is "sufficient in numbers and types of available providers to meet the healthcare needs of enrollees."
  • Twenty-seven states had rules that required some form of network-based marketplace plans to meet one or more of the quantitative measures of sufficiency.
  • Eleven states set limits on how long patients can wait for appointments. Montana, for instance, required managed care plans to ensure access to urgent care within 24 hours.
  • Nine states required insurers to update their directories at fixed intervals throughout the year while Arkansas had insurers submit an updated directory within 14 days of any change.
  • Amid consumer complaints regarding narrow networks, California introduced a bill that required regulators perform annual reviews of plans' compliance with state standards and to post their findings.

The brief concluded that as "the process of refining regulatory approaches to narrow networks moves forward on multiple tracks, it is possible that more states will pursue policies similar to those that proved popular among state officials in 2014."

For more:
- here's the brief