Policy Examples

• The Affordable Care Act established the first-ever federal rights guaranteeing private insurance consumers access to adequate networks. source
• In 2014, the National Association of Insurance Commissioners formed a subgroup to discuss how to deal with tiered networks, surprise billing and more, subsequently publishing the Health Benefit Plan Network Access and Adequacy Model Act. source & source
• In 2016, The Medicaid Managed Care Final Rule was published to mandate states to adopt network adequacy requirements — including time and distance standards — for many services provided by managed care plans. source
• In July 2018, in accordance with the Medicaid Managed Care Final Ruling, a new California law required Medi-Cal plans to provide access to outpatient mental health and substance use disorder within a maximum travel time of 30 minutes or 15 miles in urban areas, or 90 minutes or 30 miles in rural areas. source
• Florida’s Medicaid program requires that plans ensure access to behavioral health providers, including psychiatrists, other licensed practitioners, and licensed substance use treatment centers within 30 minutes travel time or 20 miles in urban counties, and within 60 minutes travel time or 45 miles in rural counties. source