WA: Hospitals Say OIC’s Draft Rules a Good Step but Insufficient

The Washington State Hospital Association, which represents 98 hospitals throughout the state, has told the state Office of the Insurance Commissioner (OIC) that its draft rules on network adequacy don’t go far enough.

In a letter to the OIC dated Dec. 20, 2013, the WSHA expressed concern that the draft “makes it far too easy for an issuer to avoid the rule’s network adequacy requirements, including the essential community provider requirements, by claiming the facility or provider refused to contract.”

The OIC released a stakeholder exposure draft of the updated network adequacy rules on Dec. 4, 2013.

The WSHA is among a number of interested stakeholders that have submitted comments to the OIC on its draft rules regarding network adequacy requirements.

According to Insurance Commissioner Mike Kreidler, providers and insurance companies each have their own criticisms of the draft.

“Providers say the draft didn’t go far enough and plans saying we‘re going too far,” Kreidler told the board of the Washington Health Benefit Exchange during its most recent meeting on Jan. 23.

In its letter, the WSHA praised the OIC for including in the draft rules provisions on spot contracting, tiered provider networks, balance billing, subcontracted networks, essential community providers, and mental health—as well as specific distance requirements and appointment standards for access to primary care and specialty care.

But the association, noting that there appears to be no similar requirement for access to acute care, requested the inclusion of the Medicaid managed care standard for access to acute care.

The rulemaking is intended to harmonize the existing rule on network adequacy with the requirements of the Affordable Care Act and to codify what issuers are required to do.

The OIC has said it hopes to issue the formal notice on the proposed rules by the end of February and to adopt the rule in March so that the carriers can see the rules before they submit their rates for 2015.