Giovannelli Justin, Lucia Kevin W, Corlette Sabrina
Center on Health Insurance Reforms, Georgetown University Health Policy Institute.
Issue Brief (Commonw Fund). 2015 May;10:1-11.
Health plans with relatively narrow provider networks have generated widespread debate, mainly concerning the level of regulatory oversight necessary to ensure plans provide consumers meaningful access to care. The Affordable Care Act creates the first federal standard for network adequacy in the commercial insurance market for plans offered through the law's insurance marketplaces. However, states continue to play a primary role in setting and enforcing network rules. This brief examines state network adequacy standards for marketplace plans in the 50 states and District of Columbia. We identify state requirements in effect at the outset of marketplace coverage, focusing on quantitative measures of network sufficiency and rules designed to ensure the delivery of accurate and timely provider directories. We then explore the extent to which those standards evolved for 2015. Though regulatory changes were limited in year one, states were most likely to act to promote network transparency and enhance oversight.
拥有相对狭窄的医疗服务提供商网络的医保计划引发了广泛的争论，主要涉及为确保医保计划能让消费者切实获得医疗服务所需的监管力度。《平价医疗法案》为通过该法案的保险市场提供的商业保险计划中的网络充足性设定了首个联邦标准。然而，各州在制定和执行网络规则方面仍发挥着主要作用。本简报审视了50个州和哥伦比亚特区针对市场计划的州网络充足性标准。我们确定了在市场覆盖开始时生效的州要求，重点关注网络充足性的量化指标以及旨在确保提供准确及时的医疗服务提供商名录的规则。然后，我们探讨了这些标准在2015年的演变程度。尽管在第一年监管变化有限，但各州最有可能采取行动以提高网络透明度并加强监管。
