Obama administration sets physician network standards for 2015 federal exchange plans

March 18, 2014

In an effort to crack down on narrow network plans and broaden patient access to physicians, the Obama administration has proposed tougher restrictions for health plans on the federal exchanges, beginning in 2015.

 

In an effort to crack down on narrow network plans and broaden patient access to physicians, the Obama administration has proposed tougher restrictions for health plans on the federal exchanges, beginning in 2015.

In order to keep premiums low for consumers, many insurance companies tightened their networks, and subsequently, many patients lost access to their care providers.

However, under the proposed guidelines, the Centers for Medicare and Medicaid Services (CMS) and the U.S. Department of Health and Human Services (HHS) will scrutinize the plans to see if they meet the “reasonable access” standard. Plans will need to include an adequate number of hospital systems, mental health providers (including those who specialize in substance use disorder services), oncology specialists, and primary care physicians.

As part of their certification or recertification process, plans also will need to include at least 30 percent of the Essential Community Providers, who care for low-income and medically underserved populations, in their service areas. 

CMS will require insurers would need to submit their provider network data, so consumers can search for physicians within their plan on Healthcare.gov. 

Narrow networks have faced significant backlash in from both providers and their patients. Last October, UnitedHealthcare dropped thousands of providers from its Medicare Advantage network in Connecticut, which prompted medical associations to file for an injunction. The plan is still embroiled in a legal battle.  

 

 

 

 

 

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