Network adequacy standards in California: how they work and why they matter

Network adequacy standards in California: how they work and why they matter

Collection:
Health Policy and Services Research
Series Title(s):
Issue brief (California HealthCare Foundation)
Author(s):
Gu, Amy Y., author
Ellson, Michele, author
Gudiksen, Katherine, author
Contributor(s):
California HealthCare Foundation, issuing body.
Publication:
[Oakland, California] : California Health Care Foundation, December 2021
Language(s):
English
Format:
Text
Subject(s):
Delivery of Health Care -- standards
Health Care Sector
Health Services Accessibility
Insurance, Health -- standards
Health Facility Merger
Medicare Part C
California
United States
Genre(s):
Technical Report
Abstract:
This issue brief examines California's regulatory framework regarding network adequacy and how effectively existing laws provide adequate and affordable access to health care providers, particularly specialists, in the commercial insurance market. Part I of this brief describes California's current regulatory framework for network adequacy and adverse benefit determination review, including the external review process. Part II examines other state and federal requirements for network adequacy and external review and compares them to those in California. Finally, Part III considers new market consolidation forces and discusses the balancing act required within the existing regulatory framework to facilitate affordable health access for all patients in California.
Copyright:
Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-ND license. (More information)
Extent:
1 online resource (1 PDF file (17 pages)).
NLM Unique ID:
9918333281706676 (See catalog record)
Permanent Link:
http://resource.nlm.nih.gov/9918333281706676