Health Reform WK-EDGE Exchange pilot for network breadth information to continue
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Wednesday, June 21, 2017

Exchange pilot for network breadth information to continue

By Kathryn S. Beard, J.D.

For plan year 2018, the network breadth pilot that gives health insurance exchange consumers in some states information about the relative size of provider networks will continue, according to an informational bulletin from CMS’ Center for Consumer Information & Insurance Oversight (CCIIO). If the pilot determines that consumers think network breadth data is a useful part of their decision-making process, the agency will consider expanding the pilot in future years (CMS Letter, June 9, 2017).

2018 will be the second year of the pilot, which gives network breadth information to exchange consumers in Maine, Ohio, Tennessee, and Texas. When they enroll, consumers in these four states are provided with information on the relative breadth of available plans’ provider networks, as compared to other available exchange plans in the county in which they reside. Data is available for three provider types: adult primary care providers; pediatricians; and hospitals.

Network breadth ratings are calculated for each qualified health plan (QHP) issuer in the four pilot states using data submitted to CMS as part of its 2018 QHP Application. Future expansion of the pilot may include additional states and/or additional provider types.

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