New Provider Network Mandate May Threaten Insurance Exchanges

The Centers for Medicare & Medicaid Services' proposal to mandate broader provider networks in public insurance exchanges could have the unintended consequence of discouraging insurer participation, according to analysts at Moody's.

After concerns in states like New Hampshire and Maine over some providers being left out of plans available in new insurance exchanges, CMS is proposing a new set of network adequacy standards for 2015. Depending on how broad the requirements end up, they could be counterproductive to the goal of using high-quality provider networks to control costs, argue Moody’s senior vice president Lisa Martin and public finance managing director Kendra Smith in a new briefing.

Under the proposal, first outlined in a summary of various proposed and final rules in early February, CMS would ask insurers selling qualified health plans for lists of all in-network and out-of-network hospitals, primary care, mental health and oncology providers to measure whether they offer patients “reasonable access” in their service areas. For essential community providers, CMS regulators are proposing extending the percentage required in a service area from 20 percent with to 30 percent, with limited exceptions.

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Source: Healthcare Payer News