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CMS Proposes HIX Guidelines for 2015

Christopher Cheney, for HealthLeaders Media, February 6, 2014

The focus points for the proposed 2015 network adequacy review process include hospital systems, mental health providers, oncology providers and primary care physicians.

The proposed guidelines also seek to increase the percentage of essential community providers in an exchange network's service area from 20 percent to 30 percent.

Insurers say they need to craft narrow networks to contain costs and offer health plans that public exchange policy holders can afford. Anthem Blue Cross Blue Shield of NH officials have said they designed a narrow network for the Granite State's federally administered exchange because they faced premium increases forecast as high as 40 percent.

"It is important to ensure patients can continue to benefit from the high-value provider networks health plans have established, which are helping to improve quality and mitigate cost increases for consumers as the new health care reforms are taking effect," said Robert Zirkelbach, vice president of strategic communications for America's Health Insurance Plans.

But providers who have been frozen out of narrow networks say the proposed new guidelines are necessary to avoid certifying networks that are at odds with the spirit of PPACA-driven health care reforms.

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