Health Reform WK-EDGE Network breadth info available to exchange consumers in four states
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Tuesday, October 18, 2016

Network breadth info available to exchange consumers in four states

By Sarah E. Baumann, J.D.

Marketplace consumers in Maine, Ohio, Tennessee, and Texas will be able to view and compare network breadthinformation for three categories of providers during the 2017 open enrollment period. As part of a pilot project intended to help CMS understand how consumers make use of information on the breadth of provider networks at the county level when choosing health insurance plans, consumers in the individual market will be able to compare networks for adult primary care providers, pediatricians, and hospitals within counties. CMS plans to continue consumer testing during the open enrollment period to improve the display of qualified health plan (QHP) information and may consider expanding the pilot to additional states in future open enrollment periods (CCIIO Bulletin, September 30, 2016).

CMS outlined its methodology for calculating network breadth ratings in its Final 2017 Annual Letter to Issuers in the Federally-facilitated Marketplaces (FFM) and in greater depth in its 2017 HHS Notice of Benefit and Payment Parameters Final rule (see FFM issuers get procedural information from CMS, March 9, 2016; Consumer-friendly changes coming to marketplace plans, March 9, 2016). It will analyze QHP provider and facility data submitted as part of the 2017 certification process and will compare an issuer’s contracted providers to the number of specific providers and facilities included across all QHP networks available in a county. CMS indicated in an August 2016 letter that it was considering six states for the pilot, but has whittled that number down to four (see CMS seeks answers on how consumers process plan information, August 24, 2016).

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