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Feds looking at PPACA plan provider networks

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The U.S. Department of Health and Human Services (HHS) could be getting ready to change the public exchange plan provider network rules.

The office of the HHS Assistant Secretary for Planning and Evaluation (ASPE) — an in-house HHS think tank — has been conducting a study on setting new rules, according to David Cusano of the Georgetown Health Policy Institute.

Cusano talked about the study at a recent meeting of the Health Insurance and Managed Care Committee, an arm of the National Association of Insurance Commissioners (NAIC). Cusano told state insurance regulators at the meeting that ASPE officials could base any proposals for network adequacy rules on the network standards that now apply to Medicare Advantage plans.

The Centers for Medicare & Medicaid Services (CMS), an arm of HHS, sets detailed standards for Medicare Advantage plans. It requires a Medicare plan to offer a minimum number of providers and set a maximum amount of time that an enrollee must travel to see an in-network provider.

The Patient Protection and Affordable Care Act (PPACA) and HHS set loose national standards for exchange qualified health plan (QHP) provider networks. States and exchanges can impose tighter standards.

Critics have argued that some insurers have created QHPs with networks so small that enrollees have a hard time getting care. Supporters say regulators should focus on solving specific network access problems and recognize that shorter, carefully created provider networks can help a plan offer good, well-coordinated care at a modest price.

Analysts at the Kaiser Family Foundation have published survey data suggesting that many uninsured people say they would rather have a cheaper plan with a smaller network than a more expensive plan with a bigger network.


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