The Department of Treasury, Labor and Health and Human Services released a four page FAQ documenton reference pricing. The FAQ reiterates that the administration will consider that large group and self-funded plans that use a reference-based pricing model for their in-network providers have met their maximum out-of-pocket requirements as long as they take steps to ensure adequate access to care.
Editor’s Note: What is the definition of “adequate access to care?” To consumers (i.e., voters), adequate access to care is a network that includes every doctor and hospital in town. Do Texas Medicaid recipients have “adequate access to care” when less than 30% of Texas physicians accept Medicaid patients? When you mix politics (politicians and bureaucrats) with free market dynamics, politics win every time.