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Michael Petruzzelli

, National Council for Behavioral Health

National Council Signs on to Letter Encouraging Network Adequacy Standards

November 19, 2014 | Health Insurance Exchanges | Comments
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The National Council signed on to a letter to the National Association of Insurance Commissioners (NAIC) encouraging them to adopt network adequacy standards that will protect consumers’ access to care, particularly specialty care like mental health and substance use treatment.  The recommendations put forth in the letter establish reasonable and meaningful standards, while still allowing for health insurance market flexibility and choice.

Network adequacy refers to a health plan’s ability to deliver the benefits promised by providing reasonable access to a sufficient number of in-network primary care and specialty physicians, as well as all health care services included under the terms of the contract. The Affordable Care Act and subsequent regulatory guidance require qualified health plans participating in the exchanges to meet certain standards for the adequacy of their provider network, including maintaining a network of a sufficient number and type of providers that specialize in mental health and substance use treatment services to ensure that services are available without an unreasonable delay.

NAIC is the standard-setting and regulatory support organization that establishes and promotes best practices for chief insurance regulators from every state in the nation.  The letter – signed by more than 100 organizations representing hospitals, physicians and other health providers serving both children and adults, as well as health care consumers and other stakeholders – proposed the following recommendations:

  • Provider networks must include a full range of primary, specialty and subspecialty providers, ensuring consumer access to all covered services;
  • Regulators must actively review and monitor all networks;
  • Appeals processes must be fair, timely, and transparent;
  • The use of tiered provider networks and formularies must be regulated to ensure that consumers of all ages have access to all covered services, including specialty services without additional cost sharing or administrative burden;
  • Insurers must be unequivocally transparent in provider selection standards; and
  • Provider directories must be accurate, up-to-date and easily accessible.

These recommendations are a part of the National Council’s continued effort to ensure robust benefits and access to providers in the health insurance Exchanges. Read the full letter here and stay tuned to Capitol Connector for the latest health insurance exchanges news.