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Monday, November 23, 2015

Feds to Set Network Adequacy Standards for ACA Exchange Plans

CMS says it plans to set minimum network adequacy standards for Affordable Care Act plans sold on insurance exchanges. There’s more good news in this than that CMS will adopt some of Texas’ consumer protections for out-of-network services. According to news reports, the CMS proposal is a departure from model legislation drafted by the National Association of Insurance Commissioners (NAIC), which was to be ratified last weekend, and which prohibits physicians from billing patients in certain circumstances. As we wrote NAIC in our most recent comment letter in what has become a long and frustrating process, “Now is the time for [CMS] and the Center for Consumer Information and Insurance Oversight to move forward and impose time and distance requirements upon insurers, as they had proposed, while leaving more stringent state standards in place.”

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