In this first installment of our “Two Takes” column occasional series, two of our experts who come from different perspectives—Caitlin Morris, who focuses on health system improvement, and Claire McAndrew, who focuses on private insurance reform and consumer protections—take on the tough questions surrounding this issue. How can we stop the unsustainable growth in health care costs if we allow consumers to continue receiving care from providers who don’t deliver good value? And on the other hand, how can we ensure that consumers can obtain adequate, timely, geographically accessible care if we further restrict their networks?
This slideshow lays out a basic explanation of what comprises an adequate network. It also describes the first-ever federal standards for network adequacy and the burgeoning number of state regulations in place to enforce them.
Communities of color continue to face a limited availability of health care providers and facilities. By including at minimum these seven features in their provider networks, insurers can help consumers in communities of color gain access to timely, high-quality, language-accessible, culturally competent health care.
This checklist is designed to help advocates and consumers understand who makes decisions about private insurance in their states. It suggests questions to ask the insurance department, state legislators, and others.
On May 26, the Centers for Medicaid and Medicare Services (CMS) released long-awaited proposed rule that seek to modernize the regulatory framework governing Medicaid managed care plans. The proposed rule aims to increase efficiency in the managed care program for providers, enrollees, and health plans, while maintaining consumer protections.
Accurate health plan provider directories are critical to ensuring that coverage works for consumers. Health plans and policymakers can take steps to reduce the prevalence of inaccuracies in provider directories.
In November, the National Association of Insurance Commissioners (NAIC), the organization composed of insurance regulators from every state in the nation, will finalize a model law to help states ensure that consumers can get access to the right health care, at the right time, without unreasonable delay. Dubbed the Network Adequacy Model Act, this draft bill is designed to be used by any state to enact provider access standards for private health insurance plans.
A year from now, consumers shopping for insurance on HealthCare.gov may be happy with some new plan choices and better protections for 2017. Earlier this month, the federal government released new proposed requirements for plans sold on the health insurance marketplaces. We applaud the government for encouraging insurers to sell “standardized plan” designs that cover more health care services before consumers meet their deductibles. But we urge the government to go further.
This year we launched a campaign to enact standards to address this issue at the state and federal level. Our campaign supports the work of advocates in many states, including close partnerships with advocates in Georgia, Maryland, and Colorado. Read about the progress those states are making!
On Monday, the Obama administration issued sweeping new standards for health insurers that operate Medicaid managed care plans for the states. The new rules are a big deal in part because they affect so many people: There are more than 72 million people enrolled in Medicaid.