Improving Healthcare Access and Combating Ghost Provider Networks.
This act aims to enhance the accuracy of healthcare provider information in health plans, reducing update times and introducing audits. It also establishes new standards for mental health and substance use disorder provider networks to ensure better access to care. Additionally, it creates support programs for citizens to resolve healthcare access issues.
Key points
Faster Provider Directory Updates: Health plans must update provider information within 30 days, down from 90, making it easier to find current data.
Protection Against "Ghost Networks": The act defines "ghost networks" and introduces mechanisms to detect them, preventing situations where directories list providers who are not accepting new patients or are not part of the network.
Audits and Public Reporting: Health plans will be required to conduct annual, independent audits of their provider directories, with results made publicly available. The government will also conduct its own audits.
Mental Health and Substance Use Disorder Support: National standards for mental health and substance use disorder provider network adequacy will be established, considering wait times and geographic accessibility.
Reimbursement Rate Parity: Standards for equal reimbursement rates for mental health and substance use disorder services compared to medical and surgical services will be introduced.
Ombudsman Programs: State and Tribal ombudsman programs will be created to help citizens understand their rights and resolve issues with healthcare access, including problems arising from inaccurate directory information.
Expired
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