title: Implementing the Affordable Care Act: state regulation of marketplace plan provider networks.
abstract: Health plans with relatively narrow provider networks have generated widespread debate, mainly concerning the level of regulatory oversight necessary to ensure plans provide consumers meaningful access to care. The Affordable Care Act creates the first federal standard for network adequacy in the commercial insurance market for plans offered through the law's insurance marketplaces. However, states continue to play a primary role in setting and enforcing network rules. This brief examines state network adequacy standards for marketplace plans in the 50 states and District of Columbia. We identify state requirements in effect at the outset of marketplace coverage, focusing on quantitative measures of network sufficiency and rules designed to ensure the delivery of accurate and timely provider directories. We then explore the extent to which those standards evolved for 2015. Though regulatory changes were limited in year one, states were most likely to act to promote network transparency and enhance oversight.
authors.affiliation: Center on Health Insurance Reforms, Georgetown University Health Policy Institute. jmg298@georgetown.edu
authors.forename: Justin
authors.initials: J
authors.lastname: Giovannelli
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Lucia
authors.forename: Sabrina
authors.initials: S
authors.lastname: Corlette
mesh_terms: D062265:Health Insurance Exchanges / Q000331:legislation & jurisprudence* / Q000592:standards; D006284:Health Plan Implementation / Q000331:legislation & jurisprudence / Q000592:standards; D006297:Health Services Accessibility; D006280:Health Workforce / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000331:legislation & jurisprudence*; D058991:Patient Protection and Affordable Care Act; D013219:State Government