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March 10, 2016 at 12:22 AM
Federal regulators are predicting that it will be quick and easy for a HealthCare.gov exchange plan issuer to let enrollees know when their provider has left the plan’s provider network.
Analysts at the Centers for Medicare & Medicaid Services (CMS) talk about the possible financial impact of a new provider network change notice requirement in a routine paperwork review filing.
CMS, an arm of the U.S. Department of Health and Human Services (HHS), runs HealthCare.gov — the system that HHS set up to handle Patient Protection and Affordable Care Act (PPACA) public exchange enrollment in states that are unable or unwilling to handle enrollment themselves.
See also: Lawmakers propose Medicare plan network stability standards
In a new regulation that sets 2017 benefit and payment parameters for PPACA mandates and programs, CMS recently created the network change notice requirements.
Starting in 2018, CMS will require a plan issuer to “make a good faith effort to provide written notice of discontinuation of a provider 30 days prior to the effective date of the change or otherwise as soon as practicable.” The issuer will have to try to send the notice to any enrollee who gets primary care from the departing provider, or who sees the departing provider on a regular basis.
The issuer can send the notice either electronically or through the mail.
CMS paperwork burden analysts estimate that about 475 issuers sell qualified health plans (QHPs) through HealthCare.gov, and that each of the QHP issuers has an average of about 7,500 providers in its network.
