Maryland Insurance Administration Hearing on Network Adequacy Regulations

On Thursday, June 2, Consumer Health First President, Leni Preston, testified at the first of a series of network adequacy hearings at the Maryland Insurance Administration. The purpose of this and future hearings is to establish by regulation the quantitative, and as appropriate, non-quantitative criteria to be used by the MIA to assess the adequacy of insurance carriers’ provider networks. The full text of our testimony can be read here, but here are the highlights:

  • We advocate the development of specific quantitative standards to serve as benchmarks by which consumers can measure the full adequacy of provider networks including time and distance standards and provider to enrollee ratios.
  • We recommend that plans be classified into three categories based on access to providers using time and distance standards, and provide the information online at HealthCare.gov.

  • We recommend having specific standards that can be monitored on an annual basis by the Commissioner, and we believe that Maryland should adopt the annual reporting process now required in Colorado.

Two documents that CHF used in developing these recommendations were: Implementing the Affordable Care Act State Regulation of Marketplace Plan Provider Networks - Commonwealth Fund, May 5, 2015; and Standards for Provider Networks: Examples from the States - Families USA.

Thursday's hearing was the first in a series of hearings. For a complete list of dates, as well as the agendas and minutes of each hearing, you can find information at the MIA Website.

Those wishing to submit comments, can do so by sending an email to networkadequacy.mia@maryland.gov.