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Network Adequacy (Revised January 29, 2016)

Carriers choosing to market a network plan in Nevada will be required to submit documentation to the Division for network adequacy determination.  The Federal Plan Management Data Templates will be used to collect the data in a uniform and consistent manner.  The data collected will then be run through a comprehensive comparison program that will identify any outliers or deficiencies for each plan network.

The scope of this review imposes technical and analytical demands upon the Division which requires outside assistance to effectively and efficiently carry out the Division’s duties. NRS 687B.490 provides for the expense of any determination made by the Commissioner to be assessed against the carrier. The Division entered into a contract with Examination Resources to provide this support.

The Division will be releasing a bulletin in the coming months which will outline the standards that will be used to determine adequacy for plan year 2017.  Additional guidance will be forthcoming in regulation R049-14 to interpret and clarify the provisions of NRS 687B.490 for plan year 2018.

Important Network Adequacy Dates for Plan Year 2017

March

March 17, 2016 - Network adequacy webinar for health benefit plans

May

May 2, 2016 –Form/Rate filings and binders due for all individual and small group health plans
May 2, 2016 - Form / Rate filings and binders due for all SADP with EOC included
May 13, 2016 - DOI sends first objection letter to carriers via SERFF
May 20, 2016 - DOI posts all proposed individual and small group health rates with approved EOC
May 27, 2016 - Revised Form/Rate and network adequacy data and documentation due in SERFF

June

June 10, 2016 - DOI sends second objection letter to carriers in SERFF
June 24, 2016 - Revised Form/Rate and network adequacy data and documentation due in SERFF

July 

July 8, 2016 - DOI sends third objection letter to carriers
July 22, 2016 - Revised Form/Rate and network adequacy data and documentation due in SERFF
July 29, 2016 - DOI makes final network adequacy determinations

 For the complete 2017 Health Benefit Plan and SADP Timeline  goto:

http://doi.nv.gov/Insurers/Life-Health/Health-Care-Reform-For-Insurers/

Health Benefit Plans (Revisions to filing instructions)

Every carrier that chooses to market a health benefit plan (network plan) in Nevada for 2017 will be required to complete and provide a  2017 Nevada  Declaration Document, Plans and Benefits Template, ECP / Network Adequacy Template, Network ID Template and Service Area Template. This requirement applies to PPO, HMO and POS networks, individual and small groups. The 2017 Declaration Document will be available for download in the coming monts. The Templates can be found at www.serff.com/hix.htm and requirements for filing have been added to the Plan Management General Instructions page. 

The Nevada Declaration Document, Plans and Benefits Template, ECP Template, Network ID Template, Service Area Template and the Membership Data Call Spreadsheet must be submitted under the “Supporting Documentation” tab in a separate/stand-alone SERFF Filing. The Carrier must select the TOI and Sub-TOI “Network Adequacy”. No filing fee required.

Dental Plans

For plan year 2017, there are no separate network adequacy filings required for standalone dental plans. Provider networks must have one (1) general dentist, one (1) pediatric dentist, one (1) oral surgeon, and one (1) orthodontist within the travel standards established by the Silver State Health Insurance Exchange.

Helpful Links

CMS 2017 Proposed Payment Letter

2016 CMS Network Adequacy Template 

NV Essential Care Provider (ECP) List for 2017