Heath care in this country has essentially become a government regulated utility. New 2022 health care mandates are causing employers more headaches and putting them at additional risk for punishing sanctions if they fail to comply. And if you have a network plan, more regulations may be coming in 2023.
It may be time to drop your network………………..
Network Adequacy Standards For QHPs And More Guidance For 2023
“HHS will review insurer-submitted network data to ensure that each plan provides access to at least one provider in each of the provider-type categories for at least 90 percent of enrollees.
As an example, at least 90 percent of enrollees would be required to have reasonable access to at least one in-network cardiologist within 75 minutes and 60 miles. If the QHP does not meet one or more of the time and distance standards, insurers could: 1) add more in-network providers to meet the standard; or 2) submit a justification to explain the discrepancy and mitigating measures that will be taken to ensure access.
Appointment Wait Times
HHS proposes a similar approach for appointment wait times. Appointment wait time standards would apply to QHPs for behavioral health services, routine primary care, and non-urgent specialty care (including for stand-alone dental plans). As proposed, enrollees must be able to secure an appointment with an in-network provider within 10 calendar days for behavioral health, 15 calendar days for routine primary care, and 30 calendar days for non-urgent specialty care.
Network Adequacy Standards For QHPs And More Guidance For 2023 | Health Affairs
