The Centers for Medicare and Medicaid Services (CMS) and the National Association of Insurance Commissioners (NAIC) have recently put out guidance that challenges states to regulate health plan provider networks in new ways. According to an article in the January edition of Managed Care, health plans should expect states to become more involved in assessing health plans’ provider networks. The article included insight from Mike Adelberg, senior director for FaegreBD Consulting, who said health plans should be proactive in ensuring that their networks meet the emerging regulatory standards.
“If the regulator has numerical standards [for network adequacy], health plans need to be routinely checking to make sure they meet those standards,” Adelberg said. Absent numerical standards, health plans could compare their networks to competitor networks to benchmark their own practices.