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 and Health Equity
On his first day in office, President Biden signed Executive Order 13985, Advancing Racial Equity and Support for Underserved Communities Through the Federal Government.
Established a government-wide initiative to advance diversity, equity, inclusion, and accessibility.
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.
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
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.
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.
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.
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.