Network Adequacy Under The Trump Administration

Network adequacy was one of the many critical issues that the Trump administration confronted when it took over responsibility for administering the Affordable Care Act (ACA). In an effort to provide greater consumer value, insurers in the ACA’s reformed Marketplace have shifted to much narrower provider networks than had existed previously. Many analysts view this as a potentially positive development, but others are concerned that patients will receive inadequate care, especially those individuals with higher-cost conditions. Regulators face the tough task of protecting patients without squelching market innovations that can control costs. Faced with these issues, the Trump administration punted. On April 13, 2017, its first health care regulation, the Market Stabilization Final Rule, “proposed to rely on State reviews for network adequacy…in States with the authority that is at least equal to the [ACA’s] reasonable access standard.” In practical terms, this shift to state oversight represents a significant departure from the Obama era. Under the Obama administration, the Centers for Medicare and Medicaid Services (CMS) reviewed all qualified health plans (QHPs) in the ACA market in states that did not operate their own exchanges. Through this review process, CMS ensured that all QHPs on the federally facilitated exchanges met basic quantitative standards designed to ensure network adequacy (see Exhibit 1). Exhibit 1: CMS Quantitative Network Adequacy Standards S...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Featured Insurance and Coverage Organization and Delivery Quality narrow provider networks network adequacy quality of care state oversight of health care Trump administration Source Type: blogs