Washington state insurance regulators want more information about provider networks from all state-regulated health plans.
The regulators want carriers to give them monthly health care provider directory updates and disclose referral and prior authorization practices in the directory.
Plans that offer different “tiers” of in-network providers — such as wider tiers for enrollees who pay more out-of-pocket and narrower tiers for enrollees who pay less — would have to disclose which providers were in which network, and how much more patients would have to pay out of pocket to see the providers in the more wider tier.
The Washington State Office of the Insurance Commissioner included those provisions in a draft of proposed provider network regulations.
Emily Brice, a representative from the office, summarized the proposal in a written presentation included in a recent Washington Health Benefit Exchange board meeting packet.
The board runs the Washington Healthplanfinder state-based public exchange.
Washington state bases its current network standards on a model rule approved by the National Association of Insurance Commissioners in 2003. The rule requires a plan to offer enough of the right types of doctors and facilities to ensure patients have access to services without undue delay, within a reasonable proximity, according to a written version of Brice’s presentation.
Washington state saw health maintenance organizations experiment with narrow networks in the 1980s and 1990s, about 20 percent of employers had cheaper, narrower network options in 2011, before most Patient Protection and Affordable Care Act changes took effect.
Some carriers competing through the new PPACA exchanges have used low-cost, narrow networks to hold down the premiums for the “qualified health plans” they sell through the exchanges.
Regulators would like to implement some of the proposed network requirements in 2015 and some in 2016.
In the future, Brice said, regulators would like to work with exchange managers to develop better tools consumers can use to understand the tradeoffs between cheaper, narrower networks and wider, more expensive networks.