WA: Insurance Commissioner to hold hearing on network adequacy

On Monday the Office of the Insurance Commissioner (OIC) announced  that a public hearing would be held for its latest rule revisions for network adequacy. This is the second round of network adequacy rule-making in the last year. The 2014 network adequacy rules were contentious, and this year’s proposed rules has produced a similar response from stakeholders.

The hearing will be held on Tuesday, July 21st from 2:00pm to 4:00pm.

Full release included below.

OLYMPIA, Wash. – The Office of the Insurance Commissioner (OIC) is holding a public hearing July 21 on a new proposed rule designed to increase transparency of health insurers’ provider networks.

The hearing is from 2-4 p.m. in the Insurance 5000 Building in Tumwater, WA.

Insurance Commissioner Mike Kreidler adopted a previous network access rule in 2014 that created uniform standards for all health insurers to follow when establishing their networks of medical providers. It also gave his office better tools to evaluate an insurer’s ability to deliver health care service to its enrollees.

This new proposed rule increases transparency for consumers by requiring health insurers to monitor who is participating in their provider networks and sets specific triggers for when the insurer must notify Kreidler’s office and its enrollees of any changes. In addition, the proposed rule:

  • Ensures enrollees do not encounter unnecessary barriers to care.
  • Requires insurers to notify their enrollees 30 days before a provider or medical facility is leaving the insurer’s network.

“Under the Affordable Care Act, consumers have more benefits, but they’re also expected to be smart shoppers of health insurance,” said Kreidler. “It’s my job to give them the tools they need to be successful and to provide them with as much transparency as possible. I also want health insurers to innovate, especially if it helps keep costs down for their policyholders. But innovation cannot be at the expense of a consumer’s ability to access care.”

Once adopted, the new rule will apply to all state-regulated health plans starting Jan. 1, 2016.

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