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Network Adequacy Model Law Passes Hurdle Toward Adoption

A new model law on network adequacy was approved by the health insurance committee of the National Association of Insurance Commissioners (NAIC) in early November. The model law, which would apply to insurance carriers in the health insurance marketplaces, would update requirements for provider directories, mental health services, telehealth, in-network protocols, and the Affordable Care Act nondiscrimination provision.

If passed by the full NAIC membership later this month, as expected, it will be the first update to existing requirements since 1996. States will then have discretion to adopt or reject the changes. The U.S. Department of Health and Human Services also is expected to consider elements of the NAIC model law for future, yet to be identified, federal regulations.

America’s Essential Hospitals previously submitted comments to NAIC and the federal Center for Consumer Information and Insurance Oversight (CCIIO). The association recommended these and other provisions to promote network adequacy for essential community providers (ECPs) and network transparency to help patients choose plans:

While the NAIC model law includes criteria to determine network adequacy based on the ability of the network to meet the needs of people with a low income, chronic or complex health conditions, disabilities, and limited English proficiency, it does not include network adequacy thresholds. NAIC suggests that these standards are more likely to be included in state-level regulations.

NAIC also opted not to include language in the model law requiring carriers to demonstrate a good faith offer of a contract to all willing ECP hospitals. But the model law does include a reminder to states that marketplace QHPs must meet the federal threshold of ECPs in their networks.

Finally, the model law would require insurance carriers to maintain a publicly available provider directory, including hospitals, to help patients make informed decisions on marketplace plans. Provider directories would be mandated to be available electronically and in print.

Contact Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Matt Buechner is the policy and advocacy associate for America's Essential Hospitals.

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