Health Law Advisor

2016 is poised to be a major year in network adequacy developments across public and private insurance markets.  Changes are ahead in the Medicare and Medicaid managed care programs, the Exchange markets and the state-regulated group and individual markets, including state-run Exchanges.  The developing standards and enforcement will vary significantly across these markets.

Through 2014 and 2015, major news stories discussed concerns over the growing use of narrow provider networks by issuers on the Affordable Care Act's insurance exchanges ("Exchanges").  Others reported on ...

The federal rate review program requires that the Centers for Medicare & Medicaid Services establish state-specific thresholds for the following year's rate review program by June 1. This year, only two states, Alaska and Wisconsin, submitted state-specific threshold proposals to the Center for Consumer Information and Insurance Oversight. Both of these requests were denied on June 1. This health reform alert provides a summary of the state-specific threshold guidance and proposals and discusses potential trends for rate review state-specific thresholds and the implications for federal rate review.

by Lynn Shapiro Snyder and Lesley R. Yeung

On December 16, 2011, the Center for Consumer Information and Insurance Oversight ("CCIIO") within the Centers for Medicare & Medicaid Services ("CMS") released a "bulletin" to provide information and solicit comments on the regulatory approach that the Department of Health and Human Services plans to propose to define essential health benefits ("EHB") under section 1302 of the Affordable Care Act. The "bulletin" provides information to stakeholders (i.e., consumers, states, employers, and health insurance issuers) about what ...