SlideShare a Scribd company logo
1 of 13
Download to read offline
Improving Network Adequacy and
Provider Directory Standards in
Georgia
Meredith Gonsahn, MPH
Health Policy Analyst
February 2, 2016
Georgians for a Healthy Future
Objectives
• Network Adequacy
• Provider Directories
• Resources
Network Adequacy
• The ability of a health plan to provide
meaningful access to all covered benefits
• An old issue with a new urgency
• Why is this important to consumers?
Current Network Adequacy Standards in Georgia
• Outdated and inadequate
• “Sufficient” and “reasonable” are open to
interpretation
• Consumers have no guaranteed benchmark for
services and enforceable rights
Policy Activity around Network Adequacy
• Federal standards and
the NAIC Model Act
• SB 158
• The Consumer and
Provider Protection Act
Study Committee
Policy Recommendations for Network Adequacy
• Multi-stakeholder process
focused on consumer
priorities
• Adopt NAIC Model Act with
Georgia-specific
modifications
• Department of Insurance
enforcement
Quantitative Standards
• Provider-to-enrollee ratios
• Time distance standards
• Maximum appointment wait
times
• Right to go out of network
• Culturally competent care
• Essential community
providers
First things first!
Transparency: An Important First Step
• Provider directories are an important tool for
consumers
• Directories are frequently inaccurate and
consumers have very little protections
• Georgia’s current standards are not robust
• SB 302
SB 302: Provider Directory Improvement Act
Accuracy provisions include requirements for:
• Regular updating of directories every 30 days
• Available in electronic (and in print upon request) to all
• A dedicated email address, telephone number, and electronic link
that consumers can use to report inaccuracies
• Annual audits of all provider directories with a protocol in place for
health plans to follow up with providers
• Health plans to contact providers participating in networks who
have not submitted claims within 12 months to determine their
network participation status
• Honoring provider directory information if it is inaccurate and a
consumer ends up out-of-network based on that information
• Health plans to report periodically to the Department of Insurance
SB 302: Provider Directory Improvement Act (Cont.)
Usability provisions include requirements for:
• Plain language information about what provider directory
applies to which plan and the criteria used by plans to build
the provider network and to tier providers
• All pertinent information about participating providers and
facilities
• Search functionality that allows consumers to search by
health care professional, whether a provider is accepting
new patients, participating office locations, participating
hospitals, and other key pieces of information
• Accommodations for the needs of individuals with
disabilities and people with limited English proficiency
Resources
• SB 158 Consumer and Provider Protection Act
• Consumer and Provider Protection Act Study
Committee Report
• SB 302
• Visit healthyfuturega.org for issue briefs:
– Ensuring Access to Care: Setting and Enforcing
Network Adequacy Standards in Georgia
– Improving Provider Directory Accuracy and
Usability
Thank you!
:
100 Edgewood Avenue, Suite 1015
Atlanta, GA 30303
Phone: 404-567-5016
Fax: 404-935-9885
info@healthyfuturega.org
healthyfuturega.org
FOLLOW & SHARE
Meredith Gonsahn, MPH
mgonsahn@healthyfuturega.org

More Related Content

What's hot

What is Meaningful use stage 2
What is Meaningful use stage 2What is Meaningful use stage 2
What is Meaningful use stage 2Nortec Ehr
 
ONC conference Presentation_Elise Kohl Grant
ONC conference Presentation_Elise Kohl GrantONC conference Presentation_Elise Kohl Grant
ONC conference Presentation_Elise Kohl GrantElise Kohl-Grant
 
Mu training 2011
Mu training 2011Mu training 2011
Mu training 2011amaresha16
 
Christopher Fincken
Christopher FinckenChristopher Fincken
Christopher FinckenLucia Garcia
 
The Role of Technology in Transforming Primary Care
The Role of Technology in Transforming Primary CareThe Role of Technology in Transforming Primary Care
The Role of Technology in Transforming Primary CareNHS England
 
RHINO Gender and Health Information Systems Forum Kick-off Webinar
RHINO Gender and Health Information Systems Forum Kick-off WebinarRHINO Gender and Health Information Systems Forum Kick-off Webinar
RHINO Gender and Health Information Systems Forum Kick-off WebinarMEASURE Evaluation
 
PCG Public Partnerships Case Study, TennCare CHOICES Program
PCG Public Partnerships Case Study, TennCare CHOICES ProgramPCG Public Partnerships Case Study, TennCare CHOICES Program
PCG Public Partnerships Case Study, TennCare CHOICES ProgramPublic Consulting Group
 
New federal health IT strategic plan promotes interoperability
New federal health IT strategic plan promotes interoperabilityNew federal health IT strategic plan promotes interoperability
New federal health IT strategic plan promotes interoperabilityDavid Sweigert
 
Future Directions In Medical Case Management
Future Directions In Medical Case ManagementFuture Directions In Medical Case Management
Future Directions In Medical Case ManagementOffice of HIV Planning
 
Opening Keynote - Personalised Health and Care 2020
Opening Keynote - Personalised Health and Care 2020Opening Keynote - Personalised Health and Care 2020
Opening Keynote - Personalised Health and Care 2020HIMSS UK
 
digital_health_2020_overview
digital_health_2020_overviewdigital_health_2020_overview
digital_health_2020_overviewWill Reedy
 
Monitoring Referrals to Strengthen Service Integration
Monitoring Referrals to Strengthen Service IntegrationMonitoring Referrals to Strengthen Service Integration
Monitoring Referrals to Strengthen Service IntegrationMEASURE Evaluation
 
Digital Health & Wellness Summit @ Mobile World Congress 2016
Digital Health & Wellness Summit @ Mobile World Congress 2016Digital Health & Wellness Summit @ Mobile World Congress 2016
Digital Health & Wellness Summit @ Mobile World Congress 20163GDR
 
Monitoring Referrals to Strengthen Service Integration
Monitoring Referrals to Strengthen Service IntegrationMonitoring Referrals to Strengthen Service Integration
Monitoring Referrals to Strengthen Service IntegrationMEASURE Evaluation
 
Mr. Michael McGrath - Interstatelivestock.com Website Demo & Update
Mr. Michael McGrath - Interstatelivestock.com Website Demo & UpdateMr. Michael McGrath - Interstatelivestock.com Website Demo & Update
Mr. Michael McGrath - Interstatelivestock.com Website Demo & UpdateJohn Blue
 

What's hot (20)

What is Meaningful use stage 2
What is Meaningful use stage 2What is Meaningful use stage 2
What is Meaningful use stage 2
 
MIHP New Possibilities JY-09
MIHP New Possibilities JY-09MIHP New Possibilities JY-09
MIHP New Possibilities JY-09
 
ONC conference Presentation_Elise Kohl Grant
ONC conference Presentation_Elise Kohl GrantONC conference Presentation_Elise Kohl Grant
ONC conference Presentation_Elise Kohl Grant
 
Tara Donnelly
Tara Donnelly Tara Donnelly
Tara Donnelly
 
Mu training 2011
Mu training 2011Mu training 2011
Mu training 2011
 
Christopher Fincken
Christopher FinckenChristopher Fincken
Christopher Fincken
 
A Report from ATA
A Report from ATAA Report from ATA
A Report from ATA
 
The Role of Technology in Transforming Primary Care
The Role of Technology in Transforming Primary CareThe Role of Technology in Transforming Primary Care
The Role of Technology in Transforming Primary Care
 
RHINO Gender and Health Information Systems Forum Kick-off Webinar
RHINO Gender and Health Information Systems Forum Kick-off WebinarRHINO Gender and Health Information Systems Forum Kick-off Webinar
RHINO Gender and Health Information Systems Forum Kick-off Webinar
 
PCG Public Partnerships Case Study, TennCare CHOICES Program
PCG Public Partnerships Case Study, TennCare CHOICES ProgramPCG Public Partnerships Case Study, TennCare CHOICES Program
PCG Public Partnerships Case Study, TennCare CHOICES Program
 
New federal health IT strategic plan promotes interoperability
New federal health IT strategic plan promotes interoperabilityNew federal health IT strategic plan promotes interoperability
New federal health IT strategic plan promotes interoperability
 
Future Directions In Medical Case Management
Future Directions In Medical Case ManagementFuture Directions In Medical Case Management
Future Directions In Medical Case Management
 
Opening Keynote - Personalised Health and Care 2020
Opening Keynote - Personalised Health and Care 2020Opening Keynote - Personalised Health and Care 2020
Opening Keynote - Personalised Health and Care 2020
 
digital_health_2020_overview
digital_health_2020_overviewdigital_health_2020_overview
digital_health_2020_overview
 
Monitoring Referrals to Strengthen Service Integration
Monitoring Referrals to Strengthen Service IntegrationMonitoring Referrals to Strengthen Service Integration
Monitoring Referrals to Strengthen Service Integration
 
Hitchhiker's Guide to Community Health and Information
Hitchhiker's Guide to Community Health and InformationHitchhiker's Guide to Community Health and Information
Hitchhiker's Guide to Community Health and Information
 
Digital Health & Wellness Summit @ Mobile World Congress 2016
Digital Health & Wellness Summit @ Mobile World Congress 2016Digital Health & Wellness Summit @ Mobile World Congress 2016
Digital Health & Wellness Summit @ Mobile World Congress 2016
 
Monitoring Referrals to Strengthen Service Integration
Monitoring Referrals to Strengthen Service IntegrationMonitoring Referrals to Strengthen Service Integration
Monitoring Referrals to Strengthen Service Integration
 
Assessing access to family planning services for the urban poor ICUH ARK 2015
Assessing access to family planning services for the urban poor ICUH ARK 2015Assessing access to family planning services for the urban poor ICUH ARK 2015
Assessing access to family planning services for the urban poor ICUH ARK 2015
 
Mr. Michael McGrath - Interstatelivestock.com Website Demo & Update
Mr. Michael McGrath - Interstatelivestock.com Website Demo & UpdateMr. Michael McGrath - Interstatelivestock.com Website Demo & Update
Mr. Michael McGrath - Interstatelivestock.com Website Demo & Update
 

Similar to Getting What You Pay For - Consumer Protections for Network Adequacy and Provider Directories

Navigating Provider Directory Accuracy Regulations
Navigating Provider Directory Accuracy RegulationsNavigating Provider Directory Accuracy Regulations
Navigating Provider Directory Accuracy RegulationsLexisNexis Risk Solutions
 
Changes in Health Care and Policy in the 2016 Georgia Legislative Session
Changes in Health Care and Policy in the 2016 Georgia Legislative SessionChanges in Health Care and Policy in the 2016 Georgia Legislative Session
Changes in Health Care and Policy in the 2016 Georgia Legislative SessionGeorgians for a Healthy Future
 
K brodsky academy health presentation 061315 final
K brodsky academy health presentation 061315 finalK brodsky academy health presentation 061315 final
K brodsky academy health presentation 061315 finalsoder145
 
The PPS [Prospective Payment System] to PDPM Pendulum: An Analysis of PDPM Co...
The PPS [Prospective Payment System] to PDPM Pendulum: An Analysis of PDPM Co...The PPS [Prospective Payment System] to PDPM Pendulum: An Analysis of PDPM Co...
The PPS [Prospective Payment System] to PDPM Pendulum: An Analysis of PDPM Co...PYA, P.C.
 
Barcellona Cshc 2010 Presentation
Barcellona Cshc 2010 PresentationBarcellona Cshc 2010 Presentation
Barcellona Cshc 2010 PresentationWilliam Barcellona
 
ONC – CMS Principles and Strategy for Accelerating Health Information Exch...
ONC – CMS  Principles and Strategy for  Accelerating Health Information  Exch...ONC – CMS  Principles and Strategy for  Accelerating Health Information  Exch...
ONC – CMS Principles and Strategy for Accelerating Health Information Exch...Brian Ahier
 
Networks: What Do Health Consumers Care About?
Networks: What Do Health Consumers Care About?Networks: What Do Health Consumers Care About?
Networks: What Do Health Consumers Care About?Health Access California
 
SAFTINet Overview for EDRC
SAFTINet Overview for EDRCSAFTINet Overview for EDRC
SAFTINet Overview for EDRCMarion Sills
 
National digital health mission ppt
National digital health mission pptNational digital health mission ppt
National digital health mission pptDhrubajyotiBora1
 
Consumers' Checkbook Submission to RWJF & HHS Provider Network Challenge
Consumers' Checkbook Submission to RWJF & HHS Provider Network ChallengeConsumers' Checkbook Submission to RWJF & HHS Provider Network Challenge
Consumers' Checkbook Submission to RWJF & HHS Provider Network Challengehealth2dev
 
Provider Perspectives Research
Provider Perspectives ResearchProvider Perspectives Research
Provider Perspectives ResearchCatalyst Investors
 
Designing an eVisit
Designing an eVisitDesigning an eVisit
Designing an eVisit3GDR
 
Designing an eVisit
Designing an eVisit  Designing an eVisit
Designing an eVisit mHealth2015
 
Nc providers council final 1 15 19
Nc providers council final 1 15 19Nc providers council final 1 15 19
Nc providers council final 1 15 19NCProvidersCouncil
 
MiHIN Overview - Health Information Exchange Meet and Greet v7 10 22-14
MiHIN Overview - Health Information Exchange Meet and Greet v7 10 22-14MiHIN Overview - Health Information Exchange Meet and Greet v7 10 22-14
MiHIN Overview - Health Information Exchange Meet and Greet v7 10 22-14mihinpr
 
PIHCI programmatic grants webinar (en) for circulation
PIHCI programmatic grants webinar (en) for circulationPIHCI programmatic grants webinar (en) for circulation
PIHCI programmatic grants webinar (en) for circulationAlexandra Enns
 

Similar to Getting What You Pay For - Consumer Protections for Network Adequacy and Provider Directories (20)

Navigating Provider Directory Accuracy Regulations
Navigating Provider Directory Accuracy RegulationsNavigating Provider Directory Accuracy Regulations
Navigating Provider Directory Accuracy Regulations
 
Changes in Health Care and Policy in the 2016 Georgia Legislative Session
Changes in Health Care and Policy in the 2016 Georgia Legislative SessionChanges in Health Care and Policy in the 2016 Georgia Legislative Session
Changes in Health Care and Policy in the 2016 Georgia Legislative Session
 
Laura Pennington, Developing a Process to Certify Patient Decision Aids in Wa...
Laura Pennington, Developing a Process to Certify Patient Decision Aids in Wa...Laura Pennington, Developing a Process to Certify Patient Decision Aids in Wa...
Laura Pennington, Developing a Process to Certify Patient Decision Aids in Wa...
 
K brodsky academy health presentation 061315 final
K brodsky academy health presentation 061315 finalK brodsky academy health presentation 061315 final
K brodsky academy health presentation 061315 final
 
The PPS [Prospective Payment System] to PDPM Pendulum: An Analysis of PDPM Co...
The PPS [Prospective Payment System] to PDPM Pendulum: An Analysis of PDPM Co...The PPS [Prospective Payment System] to PDPM Pendulum: An Analysis of PDPM Co...
The PPS [Prospective Payment System] to PDPM Pendulum: An Analysis of PDPM Co...
 
Barcellona Cshc 2010 Presentation
Barcellona Cshc 2010 PresentationBarcellona Cshc 2010 Presentation
Barcellona Cshc 2010 Presentation
 
ONC – CMS Principles and Strategy for Accelerating Health Information Exch...
ONC – CMS  Principles and Strategy for  Accelerating Health Information  Exch...ONC – CMS  Principles and Strategy for  Accelerating Health Information  Exch...
ONC – CMS Principles and Strategy for Accelerating Health Information Exch...
 
Medicaid Managed Care - Scott Brunner
Medicaid Managed Care - Scott BrunnerMedicaid Managed Care - Scott Brunner
Medicaid Managed Care - Scott Brunner
 
Networks: What Do Health Consumers Care About?
Networks: What Do Health Consumers Care About?Networks: What Do Health Consumers Care About?
Networks: What Do Health Consumers Care About?
 
Conference Call: Medicare Diabetes Prevention Program - Expansion Call
Conference Call: Medicare Diabetes Prevention Program - Expansion CallConference Call: Medicare Diabetes Prevention Program - Expansion Call
Conference Call: Medicare Diabetes Prevention Program - Expansion Call
 
SAFTINet Overview for EDRC
SAFTINet Overview for EDRCSAFTINet Overview for EDRC
SAFTINet Overview for EDRC
 
Webinar: Medicare Advantage Value-Based Insurance Design Model and Part D Pay...
Webinar: Medicare Advantage Value-Based Insurance Design Model and Part D Pay...Webinar: Medicare Advantage Value-Based Insurance Design Model and Part D Pay...
Webinar: Medicare Advantage Value-Based Insurance Design Model and Part D Pay...
 
National digital health mission ppt
National digital health mission pptNational digital health mission ppt
National digital health mission ppt
 
Consumers' Checkbook Submission to RWJF & HHS Provider Network Challenge
Consumers' Checkbook Submission to RWJF & HHS Provider Network ChallengeConsumers' Checkbook Submission to RWJF & HHS Provider Network Challenge
Consumers' Checkbook Submission to RWJF & HHS Provider Network Challenge
 
Provider Perspectives Research
Provider Perspectives ResearchProvider Perspectives Research
Provider Perspectives Research
 
Designing an eVisit
Designing an eVisitDesigning an eVisit
Designing an eVisit
 
Designing an eVisit
Designing an eVisit  Designing an eVisit
Designing an eVisit
 
Nc providers council final 1 15 19
Nc providers council final 1 15 19Nc providers council final 1 15 19
Nc providers council final 1 15 19
 
MiHIN Overview - Health Information Exchange Meet and Greet v7 10 22-14
MiHIN Overview - Health Information Exchange Meet and Greet v7 10 22-14MiHIN Overview - Health Information Exchange Meet and Greet v7 10 22-14
MiHIN Overview - Health Information Exchange Meet and Greet v7 10 22-14
 
PIHCI programmatic grants webinar (en) for circulation
PIHCI programmatic grants webinar (en) for circulationPIHCI programmatic grants webinar (en) for circulation
PIHCI programmatic grants webinar (en) for circulation
 

More from Georgians for a Healthy Future

Strong Foundations: Getting oriented to children's behavioral health in Georgia
Strong Foundations: Getting oriented to children's behavioral health in GeorgiaStrong Foundations: Getting oriented to children's behavioral health in Georgia
Strong Foundations: Getting oriented to children's behavioral health in GeorgiaGeorgians for a Healthy Future
 
Finding Policy Solutions for Provider Directories and Surprise Medical Bills
Finding Policy Solutions for Provider Directories and Surprise Medical Bills Finding Policy Solutions for Provider Directories and Surprise Medical Bills
Finding Policy Solutions for Provider Directories and Surprise Medical Bills Georgians for a Healthy Future
 
Introducing GEAR--the Georgia Enrollment Assistance Resource Network
Introducing GEAR--the Georgia Enrollment Assistance Resource NetworkIntroducing GEAR--the Georgia Enrollment Assistance Resource Network
Introducing GEAR--the Georgia Enrollment Assistance Resource NetworkGeorgians for a Healthy Future
 
Understanding Medicaid in Georgia and the Opportunity to Improve it
Understanding Medicaid in Georgia and the Opportunity to Improve itUnderstanding Medicaid in Georgia and the Opportunity to Improve it
Understanding Medicaid in Georgia and the Opportunity to Improve itGeorgians for a Healthy Future
 
Healthcare navigation for limited english proficiency (lep) groups
Healthcare navigation for limited english proficiency (lep) groupsHealthcare navigation for limited english proficiency (lep) groups
Healthcare navigation for limited english proficiency (lep) groupsGeorgians for a Healthy Future
 
Getting Georgia Covered: Best Practices, Lessons Learned, and Policy Recommen...
Getting Georgia Covered: Best Practices, Lessons Learned, and Policy Recommen...Getting Georgia Covered: Best Practices, Lessons Learned, and Policy Recommen...
Getting Georgia Covered: Best Practices, Lessons Learned, and Policy Recommen...Georgians for a Healthy Future
 

More from Georgians for a Healthy Future (16)

Strong Foundations: Getting oriented to children's behavioral health in Georgia
Strong Foundations: Getting oriented to children's behavioral health in GeorgiaStrong Foundations: Getting oriented to children's behavioral health in Georgia
Strong Foundations: Getting oriented to children's behavioral health in Georgia
 
The Power of Many: Coalitions for Policy Change
The Power of Many: Coalitions for Policy ChangeThe Power of Many: Coalitions for Policy Change
The Power of Many: Coalitions for Policy Change
 
2016 GA Legislative Preview
2016 GA Legislative Preview2016 GA Legislative Preview
2016 GA Legislative Preview
 
Finding Policy Solutions for Provider Directories and Surprise Medical Bills
Finding Policy Solutions for Provider Directories and Surprise Medical Bills Finding Policy Solutions for Provider Directories and Surprise Medical Bills
Finding Policy Solutions for Provider Directories and Surprise Medical Bills
 
Families USA NAIC Network Adequacy Summary
Families USA  NAIC Network Adequacy SummaryFamilies USA  NAIC Network Adequacy Summary
Families USA NAIC Network Adequacy Summary
 
Presentation to Trinity Presbyterian Church
Presentation to Trinity Presbyterian ChurchPresentation to Trinity Presbyterian Church
Presentation to Trinity Presbyterian Church
 
SBIRT Training in Georgia
SBIRT Training in GeorgiaSBIRT Training in Georgia
SBIRT Training in Georgia
 
Results of the Georgia BASICS SBIRT Initiative
Results of the Georgia BASICS SBIRT InitiativeResults of the Georgia BASICS SBIRT Initiative
Results of the Georgia BASICS SBIRT Initiative
 
SBIRT in Schools
SBIRT in SchoolsSBIRT in Schools
SBIRT in Schools
 
Introducing GEAR--the Georgia Enrollment Assistance Resource Network
Introducing GEAR--the Georgia Enrollment Assistance Resource NetworkIntroducing GEAR--the Georgia Enrollment Assistance Resource Network
Introducing GEAR--the Georgia Enrollment Assistance Resource Network
 
Unpacking the Affordable Care Act final
Unpacking the Affordable Care Act finalUnpacking the Affordable Care Act final
Unpacking the Affordable Care Act final
 
Understanding Medicaid in Georgia and the Opportunity to Improve it
Understanding Medicaid in Georgia and the Opportunity to Improve itUnderstanding Medicaid in Georgia and the Opportunity to Improve it
Understanding Medicaid in Georgia and the Opportunity to Improve it
 
Healthcare navigation for limited english proficiency (lep) groups
Healthcare navigation for limited english proficiency (lep) groupsHealthcare navigation for limited english proficiency (lep) groups
Healthcare navigation for limited english proficiency (lep) groups
 
Modifiable.coverage.gap.presentation
Modifiable.coverage.gap.presentationModifiable.coverage.gap.presentation
Modifiable.coverage.gap.presentation
 
Health care policy and advocacy in the 2015
Health care policy and advocacy in the 2015Health care policy and advocacy in the 2015
Health care policy and advocacy in the 2015
 
Getting Georgia Covered: Best Practices, Lessons Learned, and Policy Recommen...
Getting Georgia Covered: Best Practices, Lessons Learned, and Policy Recommen...Getting Georgia Covered: Best Practices, Lessons Learned, and Policy Recommen...
Getting Georgia Covered: Best Practices, Lessons Learned, and Policy Recommen...
 

Recently uploaded

2024: The FAR, Federal Acquisiton Regulations - Part 14
2024: The FAR, Federal Acquisiton Regulations - Part 142024: The FAR, Federal Acquisiton Regulations - Part 14
2024: The FAR, Federal Acquisiton Regulations - Part 14JSchaus & Associates
 
Understanding Year End for Town & Parish Councillors
Understanding Year End for Town & Parish CouncillorsUnderstanding Year End for Town & Parish Councillors
Understanding Year End for Town & Parish CouncillorsScribe
 
CIA Annual Global Threat Assessment 2024
CIA Annual Global Threat Assessment 2024CIA Annual Global Threat Assessment 2024
CIA Annual Global Threat Assessment 2024Energy for One World
 
CCFW_Launch slides by Nicostrato Perez, IFPRI
CCFW_Launch slides by Nicostrato Perez, IFPRICCFW_Launch slides by Nicostrato Perez, IFPRI
CCFW_Launch slides by Nicostrato Perez, IFPRIAhmed Ali
 
Canadian Immigration Tracker - January 2024.pdf
Canadian Immigration Tracker - January 2024.pdfCanadian Immigration Tracker - January 2024.pdf
Canadian Immigration Tracker - January 2024.pdfAndrew Griffith
 
Women paying the health cost of the climate crisis
Women paying the health cost of the climate crisisWomen paying the health cost of the climate crisis
Women paying the health cost of the climate crisisIIED
 
Let’s feed hungry people in kurnool.docx
Let’s feed hungry people in kurnool.docxLet’s feed hungry people in kurnool.docx
Let’s feed hungry people in kurnool.docxSERUDS INDIA
 
Behaviour_Change_Climate_Emergency_Papies_UKSBM_2024_slides.pptx
Behaviour_Change_Climate_Emergency_Papies_UKSBM_2024_slides.pptxBehaviour_Change_Climate_Emergency_Papies_UKSBM_2024_slides.pptx
Behaviour_Change_Climate_Emergency_Papies_UKSBM_2024_slides.pptxestherpapies
 
The AMAMPEMBE Royal Kingdom of South Africa.
The AMAMPEMBE Royal Kingdom of South Africa.The AMAMPEMBE Royal Kingdom of South Africa.
The AMAMPEMBE Royal Kingdom of South Africa.SUNWayResearchandInn
 
Hadley Wood Newsletter - February 2024 Edition
Hadley Wood Newsletter - February 2024 EditionHadley Wood Newsletter - February 2024 Edition
Hadley Wood Newsletter - February 2024 EditionHadleyWood Association
 
Livewell Oxygen System Tested by Texas Parks and Wildlife
Livewell Oxygen System Tested by Texas Parks and WildlifeLivewell Oxygen System Tested by Texas Parks and Wildlife
Livewell Oxygen System Tested by Texas Parks and WildlifeRandy Myers
 
About Amampembe Royal Kingdom........................
About Amampembe Royal Kingdom........................About Amampembe Royal Kingdom........................
About Amampembe Royal Kingdom........................SUNWayResearchandInn
 
Millions of Homeless Children's in world
Millions of Homeless Children's in worldMillions of Homeless Children's in world
Millions of Homeless Children's in worldSERUDS INDIA
 
PPT Item # 8 - 4821 Broadway Notice of Intent (NOI)
PPT Item # 8 - 4821 Broadway Notice of Intent (NOI)PPT Item # 8 - 4821 Broadway Notice of Intent (NOI)
PPT Item # 8 - 4821 Broadway Notice of Intent (NOI)ahcitycouncil
 

Recently uploaded (20)

2024: The FAR, Federal Acquisiton Regulations - Part 14
2024: The FAR, Federal Acquisiton Regulations - Part 142024: The FAR, Federal Acquisiton Regulations - Part 14
2024: The FAR, Federal Acquisiton Regulations - Part 14
 
Understanding Year End for Town & Parish Councillors
Understanding Year End for Town & Parish CouncillorsUnderstanding Year End for Town & Parish Councillors
Understanding Year End for Town & Parish Councillors
 
CIA Annual Global Threat Assessment 2024
CIA Annual Global Threat Assessment 2024CIA Annual Global Threat Assessment 2024
CIA Annual Global Threat Assessment 2024
 
PPT - SIGMA-GIZ Academies - Stage 1 - SIGMA opening.pdf
PPT - SIGMA-GIZ Academies - Stage 1 - SIGMA opening.pdfPPT - SIGMA-GIZ Academies - Stage 1 - SIGMA opening.pdf
PPT - SIGMA-GIZ Academies - Stage 1 - SIGMA opening.pdf
 
CCFW_Launch slides by Nicostrato Perez, IFPRI
CCFW_Launch slides by Nicostrato Perez, IFPRICCFW_Launch slides by Nicostrato Perez, IFPRI
CCFW_Launch slides by Nicostrato Perez, IFPRI
 
Canadian Immigration Tracker - January 2024.pdf
Canadian Immigration Tracker - January 2024.pdfCanadian Immigration Tracker - January 2024.pdf
Canadian Immigration Tracker - January 2024.pdf
 
Women paying the health cost of the climate crisis
Women paying the health cost of the climate crisisWomen paying the health cost of the climate crisis
Women paying the health cost of the climate crisis
 
Let’s feed hungry people in kurnool.docx
Let’s feed hungry people in kurnool.docxLet’s feed hungry people in kurnool.docx
Let’s feed hungry people in kurnool.docx
 
PPT - SIGMA-GIZ Academies - Stage 1 -Bosnia Herzegovina CAF.pdf
PPT - SIGMA-GIZ Academies - Stage 1 -Bosnia Herzegovina CAF.pdfPPT - SIGMA-GIZ Academies - Stage 1 -Bosnia Herzegovina CAF.pdf
PPT - SIGMA-GIZ Academies - Stage 1 -Bosnia Herzegovina CAF.pdf
 
No Elevators Day - Action Guide 2024 - #UseTheStairs
No Elevators Day - Action Guide 2024 - #UseTheStairsNo Elevators Day - Action Guide 2024 - #UseTheStairs
No Elevators Day - Action Guide 2024 - #UseTheStairs
 
Behaviour_Change_Climate_Emergency_Papies_UKSBM_2024_slides.pptx
Behaviour_Change_Climate_Emergency_Papies_UKSBM_2024_slides.pptxBehaviour_Change_Climate_Emergency_Papies_UKSBM_2024_slides.pptx
Behaviour_Change_Climate_Emergency_Papies_UKSBM_2024_slides.pptx
 
Highland Hills Comprehensive Plan Public Meeting #1
Highland Hills Comprehensive Plan Public Meeting #1Highland Hills Comprehensive Plan Public Meeting #1
Highland Hills Comprehensive Plan Public Meeting #1
 
The AMAMPEMBE Royal Kingdom of South Africa.
The AMAMPEMBE Royal Kingdom of South Africa.The AMAMPEMBE Royal Kingdom of South Africa.
The AMAMPEMBE Royal Kingdom of South Africa.
 
Hadley Wood Newsletter - February 2024 Edition
Hadley Wood Newsletter - February 2024 EditionHadley Wood Newsletter - February 2024 Edition
Hadley Wood Newsletter - February 2024 Edition
 
PPT - SIGMA-GIZ Academies - Stage 1 - North Macedonia CAF.pdf
PPT - SIGMA-GIZ Academies - Stage 1 - North Macedonia CAF.pdfPPT - SIGMA-GIZ Academies - Stage 1 - North Macedonia CAF.pdf
PPT - SIGMA-GIZ Academies - Stage 1 - North Macedonia CAF.pdf
 
PPT - SIGMA-GIZ Academies - Stage 1 -Montenegro CAF.pdf
PPT - SIGMA-GIZ Academies - Stage 1 -Montenegro CAF.pdfPPT - SIGMA-GIZ Academies - Stage 1 -Montenegro CAF.pdf
PPT - SIGMA-GIZ Academies - Stage 1 -Montenegro CAF.pdf
 
Livewell Oxygen System Tested by Texas Parks and Wildlife
Livewell Oxygen System Tested by Texas Parks and WildlifeLivewell Oxygen System Tested by Texas Parks and Wildlife
Livewell Oxygen System Tested by Texas Parks and Wildlife
 
About Amampembe Royal Kingdom........................
About Amampembe Royal Kingdom........................About Amampembe Royal Kingdom........................
About Amampembe Royal Kingdom........................
 
Millions of Homeless Children's in world
Millions of Homeless Children's in worldMillions of Homeless Children's in world
Millions of Homeless Children's in world
 
PPT Item # 8 - 4821 Broadway Notice of Intent (NOI)
PPT Item # 8 - 4821 Broadway Notice of Intent (NOI)PPT Item # 8 - 4821 Broadway Notice of Intent (NOI)
PPT Item # 8 - 4821 Broadway Notice of Intent (NOI)
 

Getting What You Pay For - Consumer Protections for Network Adequacy and Provider Directories

  • 1. Improving Network Adequacy and Provider Directory Standards in Georgia Meredith Gonsahn, MPH Health Policy Analyst February 2, 2016
  • 2. Georgians for a Healthy Future
  • 3. Objectives • Network Adequacy • Provider Directories • Resources
  • 4. Network Adequacy • The ability of a health plan to provide meaningful access to all covered benefits • An old issue with a new urgency • Why is this important to consumers?
  • 5. Current Network Adequacy Standards in Georgia • Outdated and inadequate • “Sufficient” and “reasonable” are open to interpretation • Consumers have no guaranteed benchmark for services and enforceable rights
  • 6. Policy Activity around Network Adequacy • Federal standards and the NAIC Model Act • SB 158 • The Consumer and Provider Protection Act Study Committee
  • 7. Policy Recommendations for Network Adequacy • Multi-stakeholder process focused on consumer priorities • Adopt NAIC Model Act with Georgia-specific modifications • Department of Insurance enforcement Quantitative Standards • Provider-to-enrollee ratios • Time distance standards • Maximum appointment wait times • Right to go out of network • Culturally competent care • Essential community providers
  • 9. Transparency: An Important First Step • Provider directories are an important tool for consumers • Directories are frequently inaccurate and consumers have very little protections • Georgia’s current standards are not robust • SB 302
  • 10. SB 302: Provider Directory Improvement Act Accuracy provisions include requirements for: • Regular updating of directories every 30 days • Available in electronic (and in print upon request) to all • A dedicated email address, telephone number, and electronic link that consumers can use to report inaccuracies • Annual audits of all provider directories with a protocol in place for health plans to follow up with providers • Health plans to contact providers participating in networks who have not submitted claims within 12 months to determine their network participation status • Honoring provider directory information if it is inaccurate and a consumer ends up out-of-network based on that information • Health plans to report periodically to the Department of Insurance
  • 11. SB 302: Provider Directory Improvement Act (Cont.) Usability provisions include requirements for: • Plain language information about what provider directory applies to which plan and the criteria used by plans to build the provider network and to tier providers • All pertinent information about participating providers and facilities • Search functionality that allows consumers to search by health care professional, whether a provider is accepting new patients, participating office locations, participating hospitals, and other key pieces of information • Accommodations for the needs of individuals with disabilities and people with limited English proficiency
  • 12. Resources • SB 158 Consumer and Provider Protection Act • Consumer and Provider Protection Act Study Committee Report • SB 302 • Visit healthyfuturega.org for issue briefs: – Ensuring Access to Care: Setting and Enforcing Network Adequacy Standards in Georgia – Improving Provider Directory Accuracy and Usability
  • 13. Thank you! : 100 Edgewood Avenue, Suite 1015 Atlanta, GA 30303 Phone: 404-567-5016 Fax: 404-935-9885 info@healthyfuturega.org healthyfuturega.org FOLLOW & SHARE Meredith Gonsahn, MPH mgonsahn@healthyfuturega.org