follow-up on a meeting held in September on this topic, NADP along with
the Life Insurance Council of New York (LICONY) responded this week
with industry views and recommendations on New York network adequacy
standards. Recommendations include that agencies consider carriers
attempts to recruit providers in shortage areas and allow for an
exemption or alternative network adequacy requirements in upstate
counties that lack “recruitable” providers. An additional meeting or
conference call may be held after the agencies review and respond to
industry recommendations.

As background,
the New York state-based health insurance marketplace, the NY State of
Health (NYSOH), and Department of Insurance (DFS) have initiated dental
network adequacy standards that derive from their Medicaid program. The
requirements include 2 General DDS, 1 Pedo, 1 Oral Surgeon and 2
Orthodontists per County; if these cannot be met, then the carrier must
reimburse out-of-network dentists at the in-network level.

The September
21 meeting was organized by LICONY and attended in person by LICONY,
NADP, Guardian, MetLife, Ameritas and Delta of CA (NY). The aim was to
encourage the NYSOH to become more flexible on the network standards and
explain to both agencies the mandate is unreasonable, specifically in
rural counties where there may be no specialty dentists.

The meeting
went well with both the NYSOH and the DFS agreeing to work with carriers
and encouraged the meeting attendees to provide recommendations on how
carriers can better illustrate the adequacy of dental networks in rural
areas. The DFS also brought up their limitation of no more than 50%
coinsurance or cost sharing for in-network dental benefits. They would
like feedback on the impact of 50% coinsurance to out-of-network

An update from this week’s meeting will be posted in Dental Interact (DI).

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