In early February the state Office of the Superintendent of Insurance (OSI) announced the creation of a Network Adequacy Working Group for the purpose of “…revising the department’s policy and regulations on health insurance provider network adequacy.”
The group will be composed of community members, health care advocates, providers, agents and brokers, legislators, and other government officials. (For reasons not yet clear, OSI will also convene a separate group for insurance carriers and industry representatives.) The group will focus on provider directory accuracy, balance/surprise billing, specialist access, network sufficiency standards, and consumer notification/education.
Network adequacy requirements are seen as one path for state health insurers to comply with provisions of Section 2706 of the ACA, and/or with state non-discrimination statutes that are based on Section 2706, such as those enacted in Oregon and Rhode Island in 2015.In early 2016, CMC provided language to a multi-discipline 2706-focused advocacy group to be used in a “Memorial,” an official resolution that was introduced in the state legislature. The statement affirms the importance of ending insurance discrimination against licensed providers. This group is coordinated by Patrick Nuzzo, DN, president of the Southwest University of Naprapathic Medicine (SUNM), who is also part of the Networking Adequacy Working Group.