FAH Hospital Policy Blog

Perspectives on health policy affecting America's hospitals and the patients we serve.

Long-Term Care | FAH Policy Blog Team

FAH Comments on Health Exchange Network Adequacy Requirements

FAH submitted comments today to CMS regarding its Notice of Benefit and Payment Parameters for 2023 proposed rule.

FAH supported CMS’ proposals to expand essential community provider (ECP) requirements and adopt more robust network adequacy standards for Exchange Qualified Health Plans (QHPs) by imposing time and distance standards, appointment wait time standards, and standards related to tiered networks. However, FAH raised concerns that the rule does not propose to include post-acute rehabilitation programs, such IRFs, CORFs, LTCHs, in the list of facility specialty types to be evaluated during network adequacy reviews, and that this will inhibit access to care for these critical specialty services.

FAH also expressed opposition related to CMS’ request for comments on its concerns that stronger network adequacy standards could be “leveraged to create an uneven playing field in network agreement negotiations that could result in higher health care costs for consumers.”

In the Proposed Rule, CMS solicits comments on a potential future rule that would limit contracting by multi-provider health systems on an “all-or-nothing” basis. FAH strongly opposed the imposition of such a rule because of the significant risk that it would harm patients by fragmenting care, promote abuse by insurance carriers, and adversely impact the Exchanges. While CMS is not making an official proposal related to these concerns, FAH will be watching the issue closely and continue to oppose any related changes.

A copy of the letter detailing all of FAH’s comments can be found here.