HHS Market Stabilization Rule Defers Network Adequacy Assessment to States

In their latest final rule, the Department of Health and Human Services will defer network adequacy evaluations to states.  States with the capacity and resources to assess the network adequacy of their health plan provider networks will have more autonomy to promote the adoption of health care innovations such as telemedicine for use by hospitals, primary care, specialty care, and virtual network providers. 

A number of states have already adopted the modernized Network Adequacy Model Act.  The recognition of telemedicine in the new model bill is essential for health plans to innovate the delivery of care and ensure consumers are provided with information about telemedicine services in their health plan provider networks.  Prime examples of telemedicine uses for network adequacy include access to highly specialized physicians, 24/7/365 health services, and the accommodation of patient choice and preferences such as language or gender.

Telehealth takeaways from the model legislation:

  • New telemedicine/telehealth definition.  The definition is concise and modality neutral. (“Telemedicine” or “Telehealth” means health care services provided through telecommunications technology by a health care professional who is at a location other than where the covered person is located.)
  • Adds new health delivery models such as telemedicine/telehealth as criteria for determining sufficient health plan network adequacy.
  • Requires all health carrier network access plans to describe how telehealth will be used to meet network access standards.