Ensuring Access to Care: Network Adequacy Survey Findings and Recommendations
Summary
Many insurers have responded to the new market demands fostered by the Affordable Care Act by offering health plans with lower premiums in exchange for more limited access to health care providers. The increasing use of “narrow networks” and tiered networks has focused additional attention on the regulation of health plan provider networks and the potential financial implications for consumers who receive out-of-network services. To develop this report, the Consumer Representatives to the NAIC commissioned Health Management Associates to evaluate the current status of state requirements related to network adequacy, the challenges regulators face, and best practices for ensuring network access. The Consumer Representatives then make recommendations for revising the NAIC’s Network Adequacy Model Act.
