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Insurance department starts network rules review
Question of the Day
CONCORD, N.H. (AP) - The New Hampshire Insurance Department on Tuesday began its lengthy and complicated work to revise how it decides whether insurance policies cover enough doctors and other providers.
At a meeting Wednesday, department officials outlined the timeline for changing the rules and described suggestions they’ve heard since announcing the undertaking in February. The next step will be using that advice to draft a proposal that will be further refined after more public comment and then submitted to the Legislature, which usually takes about six months to approve rules. The goal is to have new standards in place for plans sold in 2016.
“It’s a start to what will ultimately become the rulemaking process,” Commissioner Roger Sevigny said. “We don’t have any idea where that … will take us, but we want to seriously address any issues folks might have.”
The state’s network adequacy standards have been in the spotlight since the department approved Anthem Blue Cross and Blue Shield’s narrow network for individual health plans sold through the Affordable Care Act. Anthem is the only company selling health insurance under the federal health care overhaul law. it has been criticized for cutting 10 of the state’s 26 hospitals from its network.
But while the controversy over Anthem’s network spurred the review of the rules, insurance officials said that review must look beyond that issue, in part because the entry of two new insurance companies next year is likely to give consumers more choice and ease concerns about particular networks. Deputy Commissioner Alex Feldvebel said any rule changes need to also take into account the impact of the recently approved expansion of the state’s Medicaid system and how the delivery of health care has changed since the adequacy standards were set in 2001.
Those changes include nurse practitioners and walk-in clinics providing more primary care, and the rise of telemedicine, he said.
“Where the provider is located is starting to matter less, and we have the rising importance of actually having a system of health care that is coordinated in some way, so concepts like a medical home and accountable care organizations affect network adequacy,” he said. “And we have Medicaid expansion … and the way New Hampshire is doing it with premium assistance and commercial insurance, there’s another significant population that will come under the network adequacy rules.”
Voices for Health, a consumer advocacy group, was among those who submitted comments to the department ahead of Wednesday’s meeting. It urged the department to balance two equally important goals - promoting affordability and protecting access - and said it should start by analyzing how well the current standards are working.
“As a starting point, challenges experienced with existing networks can inform changes needed to the standards,” the group said. “And, we expect that any urgent issues that are uncovered will be addressed in an expedited manner.”
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