In a Dec. 1 letter to federal regulators, America’s Essential Hospitals expressed continued concerns about qualified health plan (QHP) network adequacy in federally facilitated marketplaces.
The letter responds to a draft 2018 letter to marketplace issuers from the Centers for Medicare & Medicaid Services Center for Consumer Information and Insurance Oversight (CCIIO). In its letter to CCIIO Director and Marketplace CEO Kevin Counihan, America’s Essential Hospitals asserted that CCIIO should:
- require issuers to offer good-faith contracts to all essential community providers (ECPs) and should develop specific requirements for including essential hospitals;
- monitor contracts offered by QHP issuers to ensure payment rates offered to ECP hospitals are adequate to support the unique services — such as trauma, burn, neonatal, and other specialty services — these essential hospitals provide; and
- ensure reviews for network adequacy evaluate QHPs, through the reasonable access review standard, to verify plan networks include hospitals that offer all of the essential services on which low-income and medically underserved patients rely.
Contact Director of Policy Erin O’Malley at firstname.lastname@example.org or 202.585.0127 with questions.