CMS won't expand pilot that checks network adequacy on HealthCare.gov
The CMS will not expand a pilot that let consumers see how many providers were offered on plans purchased on HealthCare.gov. The pilot will remain targeted to Maine, Ohio, Tennessee and Texas.
Providers were pushing for the pilot because they say narrow networks, which help insurers keep the cost of premiums down, often prevent patients from getting the care they need.
The network adequacy pilot launched last year for plans during the 2017 open-enrollment period. Rankings were based on network size in a given county. Rankings were labeled basic, standard or broad. Three types of providers—primary care, pediatricians, and hospitals—were counted.
The CMS said the pilot could grow to other states if the information proved beneficial to consumers. However, the agency in a June 9 notice said the pilot would continue for another year but would not grow to other states and that it was still gathering data on its success.
Sandy Ahn, a research professor at Georgetown's Health Policy Institute said she wasn't surprised by the CMS' decision since the agency is tinkering with various marketplace policies.
In March, Centene, which sells plans in Ohio and Texas, asked the Trump administration to cancel the pilot altogether, since the CMS is shifting all responsibility of assessing network adequacy to states.
The American College of Physicians wrote to the CMS asking them to maintain some federal oversight.
The CMS hasn't said how the pilot performed in the first year. However, Strenuus, a consulting firm that focuses on network adequacy, examined the pilot and said plans in Maine had the largest networks.
Narrow networks are most common in large metro areas that draw concentrated numbers of clinicians. Maine has no metro areas. Ohio, on the other hand, has several major cities and more narrow networks.
Nate Purpura, a spokesman for eHealth, a private health insurance exchange that's used similar network adequacy tools, said network adequacy alone should not determine quality.
They could also trap consumers who might think the broad network label automatically includes their provider, Purpura said.
Plans in the pilot states did not report any notable change on consumer choice of plans.
"Our experience is that price trumps network size," said Ken Janda, CEO of Community Health Choice, an insurer on the Texas exchange. His plans were ranked as having standard networks.
Harvard Piligrim, which had plans in Maine that were rated as standard and broad depending on the county, noticed no impact on plan selection, according to Mary Wallan, a company spokeswoman.
Molina, which sells plans in Ohio and Texas, hoped the structure of the pilot would be tweaked. It based its rankings on information from one point in time that does not take into account network revisions.
"This amounts to an unfair advantage to plans that drop providers while penalizing plans that add providers throughout the year," said Laura Murray, a company spokeswoman.
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