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May 07, 2015 at 08:23 AM
The strategies regulators use to oversee health plan provider network quality continue to vary widely from state to state, according to a team led by Sabrina Corlette.
Corlette and other health policy analysts at Georgetown University have reported on the current status of state provider network adequacy oversight in a paper distributed by the Commonwealth Fund.
The Patient Protection and Affordable Care Act of 2010 (PPACA) does require a plan sold through a PPACA public exchange to offer “‘a network that is sufficient in number and types of providers’ so that ‘all services will be accessible without unreasonable delay,’” the analysts write, quoting the text of the statute.
But PPACA itself does not include any quantitative standards, and the U.S. Department of Health and Human Services (HHS) lets states implement and enforce their own adequacy standards, Corlette and her colleagues write.
Today, the analysts say, 23 states and the District of Columbia set no quantitative standards for exchange plan provider networks.
