CMS has a big job to rework this puzzle as we have seen more than enough news that patients are running short of providers in network.  Currently the rule is at least 20% of the providersimage in the geographical areas should be available and now they are looking at increasing to 30%, which still may or may not be adequate.  In a related story in Maryland we have carriers bidding and winning a contract with no providers so the contract had to be rescinded.   

Howard County School Board in Maryland Rescinds United Healthcare Contract As Retirees Didn’t Want the Medicare Advantage Plan, No Providers Available..

Stay tuned, it could be 30% or maybe higher.  BD 

As millions of Americans join health plans created through the 2010 Patient Protection and Affordable Care Act, consumers and regulators are paying greater attention to the breadth of available coverage. Insurers say smaller networks of hospitals and doctors help contain costs and improve care. Providers serving low-income people have complained that exchange plans won’t allow them to join the networks, said Sara Rosenbaum, a professor of health policy at George Washington University.

“Everybody is obviously very concerned that what’s going to happen is their patients will be swept away -- they will not be identified as preferred providers in networks,” Rosenbaum said in a phone interview. “Clearly something has set off alarm bells.”

Federally funded health clinics, public hospitals and other providers that serve low-income people have been lobbying the government for two years to require insurers to more broadly cover their services, Dan Hawkins, vice president for federal, state and public affairs at the National Association for Community Health Centers, said in a phone interview.

“HHS has done a miserable job of establishing a decent network adequacy standard to ensure that insurers are not red-lining low-income communities and communities of color and other vulnerable populations,” he said. “For them to say we’re going to change our rules from 20 percent to 30 percent, that’s whistling past the graveyard. That’s nowhere near adequate.”


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