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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.
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.
Read the full story here: http://bit.ly/1jf7IA4
Source: Healthcare Payer News
Varied Access: The Pharmacogenetic Testing Coverage Divide
February 18th 2025On this episode of Managed Care Cast, we speak with the author of a study published in the February 2025 issue of The American Journal of Managed Care® to uncover significant differences in coverage decisions for pharmacogenetic tests across major US health insurers.
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American Advocacy and Action for Minority Health in 2025
April 4th 2025Accessing equitable health care is an ongoing struggle in the US for minority communities due to historical pretexts with new setbacks surfacing as recent administrative changes emerge, highlighting the urgent need for continued advocacy during National Minority Health Month.
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Areas of Unmet Need Continue to Burden Patients With gMG
April 2nd 2025Patient-reported outcomes measures in generalized myasthenia gravis (gMG) are more important than ever, for both those treating and being treated for the chronic autoimmune neuromuscular disorder, to have a more nuanced understanding of experiences and difficulties.
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