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  • New ACA Rules Could Increase Provider Networks in Exchanges

    New proposed rules (.pdf) released on Friday, March 14, include changes to provider network requirements that could help increase the number and variety of facilities and specialists offered by policies in the federally managed exchanges.

    The changes are part of a package of significant proposed rules that affect consumer access to quality information about the Marketplace plans, rules on Navigators, reinsurance, and medical loss ratio in 2015 and beyond. According to an article in the Washington Post, President Barack Obama described the changes to "reasonable access" standards as a response to insurance company efforts to keep costs down by narrowing provider networks.

    Under the proposed rule, the Centers for Medicare and Medicaid Services (CMS) would review plans offered on the federal exchanges to see whether they have enough facilities and specialists in several fields, such as hospitals, primary care, mental health, and oncology providers. At this point, physical therapy is not included in the list. APTA and other provider groups have been concerned about the narrow provider networks in health insurance plans sold on the exchanges.

    If the rules are adopted as proposed, beginning in 2015 plans would also be required to include 30% of an area’s "essential community providers," which the Post article describes as "usually health centers and other hospitals serving mostly low-income patients." The current requirement is for 20% inclusion.

    The rule, a final letter to insurance issuers (.pdf), and a related bulletin (.pdf) are available online. The comment period for the rule will extend for 30 days from the date of publication in the Federal Register.

    APTA continually monitors changes to the Affordable Care Act and health care reform in general, and offers an extensive list of resources on its health care reform webpage.


    • I think 30 percent is too low of a number. I can tell you how insurance company's use these networks as monopolies to push low rates and really promote poor care.

      Posted by dano napoli on 3/17/2014 3:35 PM

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