A subgroup of
the National Association of Insurance Commissioners (NAIC) has been
hosting twice weekly calls as they update the NAIC Network Adequacy
Model to reflect with the ACA provisions and increased scrutiny of
networks by the states. The subgroup consists of a variety of
stakeholders, including regulators, carriers and consumers. This Model
is critical to the insurance industry as it will become the new basis of
network regulations for the states, as well as for carriers operating
on the Federally Facilitated Marketplace (FFM).
definition of health carrier within the Model was broad enough to
potentially pull in dental carriers. NADP has proposed dental be exempt
from multiple sections of the Model and also provided language
for a separate newly drafted section to be applied specifically to
dental carriers. The new dental section parallels requirements made for
medical carriers such as continuity of care and provider directory
requirements but included multiple exemptions on issues such as
hospitals, specialists and tiered networks.
NADP will provide an overview for the NAIC subgroup on the language we
submitted and recommend acceptance of the separate dental specific
section. Edits to the proposed language are expected as much of the
current Model is undergoing constant revisions during the weekly calls.
NADP will provide an update on Dental Interact at the conclusion of the
call, expected Thursday or Friday of this week.
like to recognize and thank the NADP members of the subgroup tasked with
defining the language, meeting 2-3 times a week on conference calls in
short periods to accomplish this task. Thank you: Greg Meagher, Assurant; Kathy Larkin, Andrea Garett, Dentemax; Tequila Terry, DentaQuest; Joy Odom, Delta of CA; Rick Lantz, Amy Fensom, Delta of MI; Lynn Green, GEHA; Suzanne Suma, MetLife; Susan Hertzberg, Linzie Klein, Prinicpal and Bernard LaPine, UCCI.