CMS Takes a Stand on Minimum ACA Standards

The Centers for Medicare & Medicaid Services is taking action to ensure that Affordable Care Act policyholders have sufficient access to health care providers.

Under the ACA legislation all medical policies sold on the exchangers must have enough in-network hospitals and doctors for members so that, “all services will be accessible without unreasonable delay.” ACA-compliant plan networks must also update their provider directories monthly and include at least 30 percent of essential providers.

In a proposal released Nov. 20, the CMS — a branch of the Department of Health and Human Services — asked states to establish a quantitative measure to help guarantee policyholders’ ability to access health care. If the states don’t choose a standard, the CMS wants provider network adequacy measured by time and distance from the policyholder.