CMS Proposes HIX Guidelines for 2015

Christopher Cheney, for HealthLeaders Media , February 6, 2014

Federal regulators overseeing public health insurance exchanges are taking a fresh look at adequacy standards for so-called narrow networks, which insurers say are an essential tool for controlling healthcare costs.

In proposed guidelines released Tuesday, CMS is seeking to pry open narrow networks with stricter standards for network adequacy and inclusion of more providers who serve low-income and medically underserved patients.

"CMS is working to strengthen the network adequacy requirements that took effect for this year for the first time under the Affordable Care Act," a CMS spokesperson told HealthLeaders Media on Wednesday. "These are important provisions and include requirements that insurers have adequate provider networks for consumers, including access to essential community providers that serve low-income, medically underserved individuals."

See Also: Public HIX Give Commercial Plans a Run for Their Money

Part of the CMS guidelines released Tuesday call for a more stringent review of applications to offer health insurance policies on the public exchanges: "CMS will review the collected provider list to evaluate provider networks using a 'reasonable access' standard, and will identify networks that fail to provide access without unreasonable delay as required. … To determine whether an issuer meets the 'reasonable access' standard, CMS will focus most closely on those areas which have historically raised network adequacy concerns."

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