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CMS may impose minimum provider-network standards for ACA plans
Modern Healthcare

The CMS has proposed mandating minimum network standards for health plans sold on the federal insurance marketplace in 2017 as part of an effort to handle the broad shift toward narrow provider networks.

The Affordable Care Act requires that all medical policies on the exchanges have enough in-network hospitals and doctors for members so that “all services will be accessible without unreasonable delay.” In addition, ACA-compliant plan networks must update their provider directories monthly and include at least 30% of essential providers.

However, the 381-page proposed rule released Friday goes a step further, asking states to establish a quantitative measure to ensure ACA policyholders have sufficient access to healthcare providers. If states don’t choose a standard, the CMS proposed a default setting that would measure network adequacy by maximum travel times or distances to providers. Those minimum criteria would be established at a later date, the agency said.