CMS has issued a final letter to health insurers concerning 2015 certification requirements for qualified health plans offered through the federally facilitated marketplace or federally run small business health options program.
In line with a draft letter released last month, the final letter requires qualified health plans to have provider networks containing sufficient numbers and types of providers. That means qualified health plan provider networks must include at least 30 percent of available essential community providers, up from 20 percent in 2014. Essential community providers are those serving predominantly low-income and medically underserved individuals, according to CMS.
Earlier this month, Moody's Investors Service released a report concluding that CMS' proposed expansion of provider networks would discourage narrow networks and benefit nonprofit hospitals that treat large shares of low-income patients. The requirements described above will broaden the number and types of providers in exchange networks and subsequently protect certain essential hospitals from losing revenue or market share, according to Moody's.
Still, the overall 2014 outlook for nonprofit hospitals remains negative because of the challenges stemming from PPACA implementation. Additionally, the requirement could ultimately thwart the PPACA's goal of providing affordable, less costly care through the exchanges, according to the report.
More Articles on Provider Networks:
Moody's: Provider Network Expansion Would Benefit Safety-Net Hospitals
Kaiser Health Tracking Poll: Public Opinion on Narrow Networks Malleable
2 Main Approaches to Narrow Provider Networks