Linda Tiano Quoted in “NAIC Outlines New Rules for Health Plan Provider Networks”


Linda V. Tiano, Member of the Firm in the Health Care and Life Sciences practice, in the firm's Washington, DC, and New York offices, was quoted in Benefitnews, in “NAIC Outlines New Rules for Health Plan Provider Networks.”

Following is an excerpt:

The model Act, which hadn’t been updated since 1996, has been highly anticipated due to the changing insurance landscape under the implementation of the ACA. A controversy over the use of narrow networks on the marketplace exchanges has led the Centers for Medicare and Medicaid Services to investigate the adequacy of provider networks more closely; and the agency said it was waiting for NAIC’s revamped model law before proposing changes to its network adequacy policy for products offered on the 2016 exchanges.

“Accordingly, the model act may have far reaching implications for health plans and provider networks,” says Linda Tiano, a member of the health and life sciences practice at the law firm Epstein Becker Green.

“The NAIC’s model laws are often adopted by legislatures and federal and state regulators, and CMS has stated it will revise its own network adequacy laws based on what the NAIC recommends,” she says in a client alert about the draft Act. “Accordingly, it is important for any insurer that utilizes provider networks and for the provider networks themselves to understand how these provisions may impact them.”

The draft model law includes several changes to the existing NAIC model, most notably the use of the term “managed care plan” has been replaced by “network plan.”