CMS released its Medicaid Managed Care Final Rule regarding managed care
in Medicaid and the Children's Health Insurance Program, which
revises and expands federal rules governing contracting and payment
of Medicaid managed care plans. The Final Rule includes provisions
regarding "network adequacy standards" and advises states
to contemplate telemedicine and other technological solutions to
ensure beneficiaries have reasonable access to all necessary care
in order to obtain reimbursements. Additionally, the National
Association of Insurance Commissioners previously released its model legislation for health benefit plan
network access and adequacy ("Model Act"). The Model Act
is designed for use by state legislatures. Like the Medicaid
Managed Care Final Rule, the Model Act establishes standards for
network adequacy. In doing so, the Model Act recognizes telehealth
as an acceptable means (among others) of achieving network
adequacy. These developments demonstrate the increasing acceptance
of telehealth in the mainstream healthcare delivery system and
illustrate how telehealth may be used as an essential element of
network development and adequacy.
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