Resource Center for Health Plan Regulators

Welcome to a space designed for federal and state regulators, insurance commissioners, and health policymakers at all levels to drive conversations around ensuring timely and appropriate access to care.

Network Adequacy:

Shaping the Future of Healthcare

As a health plan regulator, you’re tasked with ensuring that consumers have access to high-quality, affordable coverage that meets their needs. What’s more? You need to be able to demonstrate sound policy and fiduciary oversight of health plans. That’s a lot to keep up with. And we’re here to help.

Over the past 15 years, we have been the trusted partner to the Centers of Medicare & Medicaid Services and more than 20 state regulators who oversee provider network adequacy for insurers. Regulators use our solutions, services and expertise to drive the evolution of network adequacy standards, improve provider directory accuracy, monitor compliance with health plan requirements, and provide transparency and consumer protections in the marketplace.

We are continually collaborating with federal policymakers, State Insurance Commissioners and State Medicaid Directors, helping them develop strong oversight of health plans to ensure they meet all federal and state regulatory requirements. We welcome the opportunity to meet with you and discuss how we can further support your efforts to improve access to care.

Press Release:

CMS Extends Its Contract With Quest Analytics

The Centers for Medicare & Medicaid Services (CMS) has extended their contract with Quest Analytics for an additional five-year term to measure the adequacy of all Medicare Advantage Part C & D and Medicare-Medicaid Health Plans’ (MMP) provider, facility and pharmacy networks. Read the Press Release

CMS Extends Contract With Quest Analytics

Medicaid

Federal Medicaid Network Adequacy Standards

Quest Analytics stands by to partner with State Medicaid Agencies to help develop quantitative network adequacy standards that are compliant with federal standards outlined in this brief. Given Quest Analytics’ knowledge of evidence-based quantitative network adequacy standards, our strong relationships with network adequacy leaders inside the Centers for Medicare & Medicaid Services, and our contractual relationships with Managed Care Organizations, Quest Analytics is in a strong position to offer expert assistance to any State in the development of standards.

The Marketplace

Quest Analytics Comments on the Notice of Benefit and Payment Parameters for 2023

Incorporate health equity measures into existing network adequacy standards

In January 2022, we submitted a comment letter to the Center for Medicare & Medicaid Services (CMS) on the agency’s request for feedback related to advancing Health Equity in Qualified Health Plan Certification. As part of our mission to improve access to health care, our letter proposed that CMS consider creating a framework to incorporate health equity measures in the Qualified Health Plan Certification and Network Adequacy Standards. While our response was directed toward a federal comment period, we welcome health plan regulators at all levels to review this framework for addressing the health equity needs of their consumers.

Exorcizing Ghost Networks

Ghost networks are a major issue facing US health plan consumers. As state and federal regulators seek to empower consumers with accurate information on their coverage choices, they have identified the need to provide consumers with accurate provider directories. This paper discusses the problem and offers solutions for federal and state regulators to consider.

Commercial

No Surprises Act: Provider Directory Verification

Enforcement Guidance for Regulators

The No Surprises Act is a game-changer for health plan oversight. Focusing specifically on the proposed rules for provider directory verification, Section 116, the No Surprises Act will increase the importance of data governance and plan evaluation. The enforcement of Section 116 involves both federal and state regulators. Regulators at the federal and state level may be interested in understanding the various plan management strategies and how health plans can demonstrate a good faith compliance effort to implement the requirements set forth in Section 116.

State Health Insurance Marketplace Types, 2022

Discover how a Department of Insurance is using Quest Enterprise Services to automate network review and make better-informed decisions regarding public policy.

When the Department of Insurance was using outdated technology to manage its network review processes, it needed a way to streamline the process of monitoring health plans, easily identify areas of insufficient network adequacy for specific specialties, and quickly be able to compare performance between health plans.

Together, we are working toward improved access to high-quality healthcare across the country.

As you work to ensure that the health plans in your state offer affordable and quality healthcare, Quest Analytics is here to help. Contact us if you have any questions or would like to discuss how we can support your efforts.

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