The Three Trends That Will Carry Into Next Year

Managed Healthcare Executive

Helaine I. Fingold and John W. Eriksen, attorneys in the Health Care and Life Sciences practice, in the firm’s Baltimore and Washington, DC, offices, respectively, authored an article in Managed Healthcare Executive titled “The Three Trends That Will Carry Into Next Year.”

Following is an excerpt:

Network adequacy has been a hot topic in 2015. Efforts to keep plan costs low through narrower contracted networks have raised access concerns across all markets, though particularly in the individual and small group sectors. In response, regulators are reassessing their network adequacy standards and review processes to ensure that plans can provide appropriate access. The National Association of Insurance Commissioners is updating its model network adequacy rules, which federal regulators will take into consideration as they further develop network adequacy standards for the health insurance exchange markets. Medicare is moving to include network adequacy review in its annual plan audit protocol. In addition, proposed Medicaid rules would require states to establish time and distance standards, and would include physical accessibility and cultural competence in determining network adequacy.