Hartford Business Journal

February 6, 2017

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4 Hartford Business Journal • February 6, 2017 www.HartfordBusiness.com w w w. H a r t f o r d B u s i n e s s . c o m (860) 236-9998 E D I T O R I A L Greg Bordonaro Editor, ext. 139 gbordonaro@HartfordBusiness.com Gregory Seay News Editor, ext. 144 gseay@HartfordBusiness.com Matt Pilon News Editor, ext. 143 mpilon@HartfordBusiness.com John Stearns Staff Writer, ext. 145 jstearns@HartfordBusiness.com Patricia Daddona Web Editor, ext. 127 pdaddona@HartfordBusiness.com Stephanie Meagher Research Director Heide Martin Research Assistant B U S I N E S S Joe Zwiebel President and Publisher, ext. 132 jzwiebel@HartfordBusiness.com Donna Collins Associate Publisher, ext. 121 dcollins@HartfordBusiness.com Allison Williams Office & Sales Coordinator, ext. 122 awilliams@HartfordBusiness.com Amy Orsini Events Manager, ext. 134 aorsini@HartfordBusiness.com Kaleigh Hickey Events Coordinator, ext. 137 khickey@hartfordbusiness.com Christian J. 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Box 330, Congers, NY 10920-9894 www.copyright.com Health Plan Scrutiny Network adequacy Network adequacy is defined by the National Conference of State Legislatures as "a health plan's ability to deliver the benefits promised by providing reasonable access to a sufficient number of in-network primary care and specialty physicians, as well as all healthcare services included under the terms of the contract." The federal government has crafted adequa- cy rules for Medicare Advantage and Obam- acare plans. The regulations now taking effect in Connecticut are similar in many ways. Under previous Connecticut law, insurers were required to attest they were accredited by one of two accrediting entities that moni- tor network adequacy, but the state played no role in that oversight. Doctors weren't satisfied with that being the sole requirement, as accreditation involves more than just network adequacy. If a health plan failed the adequacy standards but did well in other areas, it would still pass, Katz said. Wade said the accreditors — National Committee for Quality Assurance and URAC — have robust and regularly updated stan- dards, but the new rules allow the state to check their work and make its own decision. A spokesman for the Connecticut Asso- ciation of Health Plans did not respond to requests for comment. The law gives Wade wide latitude in how she reviews networks. There is no specif- ic formula she's mandated to use, but her review could include such metrics as pro- vider-patient ratios, geographic availability and wait times. Doctors have pushed for specific metrics to be applied and Katz said his organization intends to pursue further legislation to make that happen. Asked if she would be in favor of stricter rules, Wade said she would need to see a spe- cific proposal first. "The law just went on the books, so we need to give it a little bit of time to work," she said, add- ing that her office will listen to any complaints. Gordon, the oncologist, said he hopes the new rules lead to noticeable improvements in the year ahead. He said he has increasingly had trouble referring patients to other in-network doc- tors. Some might be far away, while others may not have openings for several weeks or more. That, to him, is inadequate. Insurer directories can also come into play when referring patients. Since Gordon's staff uses them to help determine where to send patients, inaccuracies can cause delays and other issues, he said. n MEDIA SPONSOR

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