NAIC approves model network adequacy law

The National Association of Insurance Commissioners voted this weekend to approve model state-level legislation to ensure health insurance provider network adequacy. They did so after a lengthy 18-month process that included extensive engagement with health plans, providers, consumer advocates and state insurance commissioners. The AHA strongly supports the revised model act, which increases state regulator oversight of provider networks and provides greater health plan transparency. In particular, the model legislation provides a framework for addressing unexpected bills that some consumers face when getting care from out-of-network physicians at in-network hospitals. Specifically, it includes a structured mediation process between the out-of-network physician and the health plan when the health plan’s payment approach is not considered reasonable by the out-of-network health care professional. In addition, the model act includes new definitions for tiered networks and new requirements for provider directories. State legislatures could consider the model bill in 2016.