CMS proposes review of provider networks in federal exchange

Health plans offered through the federal exchange may need to expand their provider networks starting in 2015. The Centers for Medicare and Medicaid Services (CMS) recently notified health plans that if they intend to participate in the federal exchange in 2015, CMS will begin reviewing in-network provider lists prospectively to ensure that there is "reasonable access" to health care. CMS will be focusing on areas where there have been access problems in the past, including hospital systems, mental health providers, oncology providers, and primary care providers. Additionally, CMS announced that it is considering a requirement for federal qualified health plans to include more federally funded health clinics, safety-net hospitals and other medical providers utilized by low-income individuals.

This proposed policy change is in response to provider complaints that they are being left out of the new, narrow provider networks. California regulators need to hear from doctors of optometry and their patients, too! If you are being excluded from a provider network offering coverage within Covered California, California's health insurance exchange, please contact Kara Corches. She can help you and/or your patient file a complaint with the appropriate regulatory agency.

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