State Efforts to Implement the NAIC Network Adequacy Model Act NAIC Summer Meeting San Diego, CA August 28, 2016 Claire McAndrew Families USA Cindy Zeldin Georgians for a Healthy Future Debra Judy Colorado Consumer Health Initiative Adrienne Ellis Mental Health Association of MD 1

NAIC Network Access and Adequacy Model Act Updated version adopted November 22, 2015 8/28/2016 NAIC Consumer Liaison

States and the NAIC Network Adequacy Model Act CA SB 137: Provider Directories- October 2015 FL HB 221: Surprise Medical Bills- April 2016 CT SB 433: Multiple Provisions- June 2016 CT: Network sufficiency, continuity of care, provider directories Many other states are continuing to work on this issue now, insurance regulators and legislators are examining the model and looking to implement it, that is certainly happening where I live in the District of Columbia and I know it is happening elsewhere as well. 8/28/2016 NAIC Consumer Liaison

Georgia Legislation to Improve Provider Directories Legislation incorporating NAIC model act language on provider directories (SB 302) signed into law in May 2016 Collaborative effort between consumer advocates, industry stakeholders, and state policymakers Followed a legislative study committee process in Fall 2015 on provider & consumer protections 8/28/2016 NAIC Consumer Liaison

Georgia Legislation to Improve Provider Directories How Consumer Advocates Contributed to This Process: Through partnerships with enrollment assisters, consumer groups were hearing about provider directory errors Secret shopper study conducted by Georgians for a Healthy Future found ¾ of listings had at least one error Raised awareness with media Next Steps: Regulations (2016) and Implementation (2017) 8/28/2016 NAIC Consumer Liaison

Georgia Legislation to Improve Provider Directories Key Elements of SB 302 Insurers must allow the public to report directory inaccuracies. Must investigate reports and modify accordingly within 30 days. Insurers must review and update entire directories by January 1, 2017. Annually after, must audit reasonable sample of directories. Insurers must contact providers that haven’t submitted claims within 12 months. If can’t reach providers within 30 days, must remove them. Consumers held harmless from excess costs when rely on materially inaccurate directory info and subsequently receive care from out-of-network providers. 8/28/2016 NAIC Consumer Liaison

Maryland’s Path to Adopting Network Standards Consumer groups publish reports on access problems State Marketplace convened network adequacy workgroup Advocates convened stakeholder group NAIC network adequacy model act is adopted 2015 Legislation introduced 2016 legislative session Workgroup of diverse stakeholders convened to hammer out differences and force compromise Consensus legislation passed and signed by the governor on 4/28/2016 2016 Maryland Insurance Administration is currently working with stakeholders to develop regulation required by legal statute by December 2017 2017 8/28/2016 NAIC Consumer Liaison

Maryland’s New Law Requires Maryland Insurance Administration review of network access plans Development of regulations with quantitative standards New provider directory information Periodic audits to ensure directory accuracy; system for public to report directory errors Insurer provided information on how consumers may access of network care if they experience unreasonable delay or travel in accessing specialty care 8/28/2016 NAIC Consumer Liaison

Colorado’s Path to Adopting Network Standards DOI-commissioned reports on carrier networks released Priorities and process identified Stakeholder meetings on draft bulletins Final bulletins issued Next step: rulemaking to turn the bulletins into regulations based on time and distance standards with 2014 and 2015 data 8/28/2016 NAIC Consumer Liaison

Scope of Colorado Bulletins Metrics for measuring networks Access plan contents Provider directories Continuity of care 8/28/2016 NAIC Consumer Liaison

Recommendations Meet with stakeholders early and often Collaborate to determine best vehicle (regulatory/legislative) and process to move Model Act Look to other states as models for how to modify Act to fit needs; customize to fit your own state Learn the consumer experience -Involve stakeholders early and often. Take advantage of stakeholder-produced data, such as secret shopper studies. -Collaborate with other policymakers and stakeholders to identify opportunities/develop consensus around process for implementing the model act. Some states have regulatory authority within insurance department, some may need legislation. Look to ideas from other states on how to enact the particular areas of the model that you think are most pressing to address in your state. There are a wide variety of ways states have already customized the Model Act to fit their needs. -Mine complaint data/ reach out to navigators- learn the consumer experience 8/28/2016 NAIC Consumer Liaison

Questions? Claire McAndrew Families USA cmcandrew@familiesusa.org Cindy Zeldin Georgians for a Healthy Future czeldin@healthyfuturega.org Debra Judy Colorado Consumer Health Initiative djudy@cohealthinitiative.org Adrienne Ellis Mental Health Association of MD aellis@mhamd.org 8/28/2016 NAIC Consumer Liaison