Calif. backs tougher rules on plan net­works

Modern Healthcare - - NEWS - By Paul Demko

A bill passed by Cal­i­for­nia law­mak­ers last month ad­dress­ing the ad­e­quacy of provider net­works could mark an im­por­tant de­vel­op­ment in the na­tional po­lit­i­cal and pol­icy de­bate over nar­row net­works.

Un­der the bill, which Gov. Jerry Brown had not signed as of Fri­day, Cal­i­for­nia health plans would face new re­quire­ments de­signed to en­sure they of­fer ad­e­quate provider net­works. In­sur­ers would have to pro­vide an­nual re­ports to the Cal­i­for­nia Depart­ment of Man­aged Health Care about their net­works, and the agency’s as­sess­ment of that data would be posted on its web­site. Brown’s of­fice did not in­di­cate whether the gov­er­nor would sign the bill.

“We be­lieve that we’re in good shape for him to sign it,” said An­thony Wright, ex­ec­u­tive di­rec­tor of Health Ac­cess Cal­i­for­nia, which backed the bill.

Many health­care and con­sumer groups support the bill, in­clud­ing the Cal­i­for­nia Med­i­cal As­so­ci­a­tion and AARP. But the Cal­i­for­nia As­so­ci­a­tion of Health Plans op­posed the mea­sure, ar­gu­ing that there are al­ready suf­fi­cient safe­guards to en­sure net­work ad­e­quacy. The Cal­i­for­nia Depart­ment of Fi­nance op­posed the bill on sim­i­lar grounds, warn­ing that it could cause fi­nan­cial prob­lems for the state Medi-Cal pro­gram.

The nar­row net­work is­sue has been a volatile one in Cal­i­for­nia. Law­suits have been filed against An­them Blue Cross and Blue Shield of Cal­i­for­nia al­leg­ing they mis­led con­sumers about their provider net­works. Those two in­sur­ers at­tracted the largest share of cus­tomers dur­ing the first open en­roll- ment pe­riod, ac­count­ing for nearly 60% of Cov­ered Cal­i­for­nia signups. Cal­i­for­nia reg­u­la­tors are also in­ves­ti­gat­ing net­work-re­lated com­plaints against the in­sur­ers.

But many ex­perts say in­sur­ers’ nar­row net­works have en­abled them to of­fer lower rates. The av­er­age pro­posed statewide rate in­crease for 2015 pre­mi­ums in Cal­i­for­nia is 4.2%, Cov­ered Cal­i­for­nia an­nounced in July.

Wright said that there have been long­stand­ing ques­tions about net­work ad­e­quacy for Medi-Cal man­aged-care plans and pri­vate cov­er­age op­tions. “We thought it was cru­cial that there be scru­tiny that peo­ple, once cov­ered, have ac­cess to the care that they were promised,” he said. “The con­ver­sa­tion around Cov­ered Cal­i­for­nia nar­row net­works only made that more ur­gent.”

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