Work on Revised Network Adequacy Model Act Continues at PAI

North Carolina Medical Society (NCMS) CEO Robert W. Seligson, in his role as the President of the Physicians Advocacy Institute, Inc. (PAI), is working closely with the National Association of Insurance Commissioners (NAIC) to revise its Model Managed Care Plan Network Adequacy Model Act.

Recently, PAI devised a list of key advocacy points that the Institute and medical societies throughout the country will address with insurance commissioners as they revise the NAIC’s Network Adequacy Model Act.

The adequacy of provider networks marketed by health insurance carriers, particularly those networks established for health plan products within health insurance exchanges, is of growing concern to physicians and patients alike. State and federal regulators are responding with efforts to enhance regulatory scrutiny as insurers significantly revise networks including eliminating physician contracts to create “narrow” networks – to contain costs.

The revised Model Act will provide a template for states as they work to ensure that health insurers offer provider networks that afford beneficiaries sufficient access to health care providers and the full range of their covered health plan benefits.

PAI representatives and regulators are holding weekly conference calls on the matter and hope to have a revised Model Act complete by mid-winter.

Among issues being discussed is ‘tiering’ of providers, inaccurate provider directories and termination of contracted providers without cause immediately prior to or during the plan open enrollment period causing significant access disruption to patients.

Read what the AMA has to say about Network Adequacy on their advocacy page.


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