WA: Carriers ask for more clarity in OIC Network Access rules

TUMWATER, WA — On Tuesday, the Office of the Insurance Commissioner (OIC) held a public hearing for the latest proposed rule-making for network access. Representatives of health plans as well as providers testified at the hearing. Cambia and Premera/Lifewise vocalized their concerns around clarity of the document and feasibility of certain notification requirements.

Of utmost concern for carriers was the following proposed language:

If the OIC determines that a network is out of compliance with [network adequacy rules] and the issuer has failed to report this change to the OIC, the issuer must, within one business day of notification by the OIC, submit an alternate access delivery request…and supporting documentation for the alternate access delivery request.

The alternate access deliver request (AADR) is required when a carrier cannot maintain an adequate network of providers and must provide an alternative means to ensure access to medically necessary services for members. According to Zach Snyder, Health Policy Analyst at Cambia, he has never seen an AADR completed in one business day. He asked that the notification be changed to five business days. Waltraut Lehmann, Manager of Regulatory Affairs at Premera/Lifewise, added that this rule would “set up companies for failure.”

Carriers have been voicing these concerns for several iterations of the draft Network Access Rules. See a full list of submitted written testimony here.

The OIC intends to adopt these rules on July 24th effective for Plan Year 2016.