PAI Working with Insurance Commissioners to Revise Its Network Adequacy Model Act

The North Carolina Medical Society (NCMS) through its involvement with the Physicians Advocacy Institute, Inc. (PAI) is working closely with the National Association of Insurance Commissioners (NAIC) to revise its Model Managed Care Plan Network Adequacy Model Act. NCMS CEO Robert W. Seligson, who also is PAI’s President, sent a letter to NAIC outlining important changes both PAI and many medical societies nationwide would like to see in the NAIC’s Network Adequacy Model Act.

“In this rapidly changing environment, it is more challenging than ever for state regulators to ensure the adequacy of provider networks that carriers establish to provide health care benefits to their beneficiaries,” Seligson wrote. “There is growing consensus about the need for consistent and specific network adequacy standards.”

Among recommendations to the work group, the letter urges NAIC to address problems with ‘tiering’ of providers, inaccurate provider directories and termination of contracted providers without cause immediately prior to or during the plan open enrollment period causing significant access disruption to patients.

Read the entire letter for all the details.



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